When dealing with critically ill patients receiving mechanical ventilation, researchers suggest there is no association between the level of backrest elevation and changes in sacral tissue integrity.

Placing patients in backrest positions of less than 30 degrees is believed to reduce pressure on bony prominences that are most at risk for pressure injury, while higher backrest positions are recommended to reduce the risk of ventilator-associated pneumonia (VAP) among these patients.

However, a study published in the American Journal of Critical Care suggests that changing the patients’ backrest elevation may not be as important or as effective in preventing pressure injuries as once thought, notes a media release from American Association of Critical-Care Nurses.

“The theory that higher backrest elevation heightens the risk for pressure injury has led to recommendations that may not provide expected outcomes. We found no association between backrest elevation and changes in tissue integrity,” says the study’s principal investigator Mary Jo Grap, PhD, RN, nursing alumni distinguished professor at Virginia Commonwealth University’s School of Nursing, in the release.

The research is based on a longitudinal, descriptive study of tissue integrity of 150 patients receiving mechanical ventilation in three intensive care units at VCU Health System. A total of 84 patients enrolled in the study had data on both backrest elevation and skin integrity for evaluation of daily tissue changes for one or more of the 24-, 48- or 72-hour observation periods.

Assessments indicated participants were high-acuity patients at high risk for pressure injury, and all had a barrier to help prevent pressure injuries in the sacral area.

Overall, the largest proportion of time was spent at a backrest elevation of 20 to 30 degrees, whether participants had no pressure injury, an injury with no change, an injury that was improving or an injury that was worsening. The amount of time spent at less than 20 degrees or greater than 30 degrees was fairly evenly divided for participants with no injury or for those with an injury that had no change during the observation period, but it varied widely for those whose injury had changed (worsened or improved), the release explains.

Data analysis showed no significant difference among the proportions of time spent at various backrest elevations between the four injury categories. Further, effect sizes for the injury categories were small.

Overall, the researchers found that backrest elevation had no effect on the integrity of sacral tissue. They recommend that future research focus on position types, turning frequency and other factors that may influence the development of pressure injuries, per the release.

[Source(s): American Association of Critical-Care Nurses, Newswise]