Does Head of the Bed Elevation of 45 Degrees Vs Supine Position Prevent Aspiration and the Development Of Pneumonia in Ventilator Dependent Patient's?

Pneumonia is an infection that causes the air sacs in one or both of the lungs to become inflamed. These air sacs are responsible for gas exchange. When they are filled with fluid or pus this causes a cough and difficulty of breathing. Many things such as aspiration, a prolonged hospital stay, bacteria, fungi, or viruses including the common cold can cause pneumonia. Some of the risk factors for developing pneumonia are age greater then 65, weakened immune system, smokers, chronic diseases, or people who have been placed on a ventilator. Complications of pneumonia are getting bacteria in the blood stream, lung abbesses, fluid accumulation in the lungs, or getting poor oxygenation. The signs to look for are fever, sweating, cough, thick mucous, chest pain, and shortness of breath, fatigue, nausea, vomiting, muscle aches or a headache. Treatment includes antibiotics, antiviral medications, fever reducers, and cough suppressants. The question I’m researching today is does head of the bed elevation of 45 degrees vs supine position prevent aspiration and the development of pneumonia in ventilator dependent patients?

Ventilator-acquired pneumonia (VAP) is defined by the Center for Disease Control as “A pneumonia where the patient is on mechanical ventilation for >2 calendar days on the date of event, with day of ventilator placement being Day 1” (2014). Pneumonia is an unfortunate risk factor of being intubated for any period of time due to the increase chance for aspiration. Aspiration of gastric contents is a major route for bacteria to enter the lungs. Intubation increases the patient’s risk of acquiring infections compared to patients who are not intubated. The factors that might increase the patient’s chances of developing ventilat...

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...e aware of the signs of developing pneumonia and intervene as soon as possible. Their role is to assess and make changes based on the patient’s condition.

In conclusion there seems to be varying inferences about the correlation between having the head of the bed elevated at a 45 degree and decreasing ventilator-acquired pneumonia. Most research shows a decrease but none have stated with absolute certainty practicing this intervention is effective. Research has also shown evidence of a decrease in aspiration of patients who have a head of the bed evaluation of 45-degree angle. This is important since aspiration is a huge risk factor of developing pneumonia. Experts still highly recommend that patients who are intubated be kept with their head of the bed at a 45-degree angle unless contraindicated. Always base interventions and positions on the specific patient.