Clinical estimation of trunk position among mechanically ventilated patients

Intensive Care Medicine
J P McMullinG H Guyatt

Abstract

Trunk position at 45 degrees from the horizontal is associated with a decreased risk of gastroesophageal aspiration. The objectives of this study were to determine the accuracy of trunk flexion estimates compared to a reference standard measurement, and to determine agreement about trunk flexion among ICU clinicians. Prospective observational study. Two university-affiliated medical-surgical ICUs. Thirty-three mechanically ventilated ICU patients, seven residents, two fellows, three intensivists, and twenty-eight bedside nurses. Prospectively, concurrently, and independently during rounds, one bedside nurse, one resident, one fellow, and one intensivist clinically estimated the trunk flexion of mechanically ventilated patients. To record the reference standard, a trained investigator measured trunk position in the vertical plane using a goniometer. We made 438 clinical assessments on 33 patients aged 57.2+/-19.4 (SD) years with an APACHE II score of 27.3+/-9.4. Mean trunk flexion estimates were: nurses 24.3+/-12.3 degrees from the horizontal, residents 20.2+/-13.7, fellows 20.3+/-10.8, and intensivists 21.1+/-13.1 compared to the reference standard measurement 16.2+/-9.0 degrees. The accuracy of trunk flexion estimates was fair...Continue Reading

Citations

Aug 10, 2006·Intensive Care Medicine·Jean-Christophe M RichardLaurent Brochard
Aug 13, 2014·Journal of Research in Pharmacy Practice·Hadi HamishehkarAta Mahmoodpoor
Jul 26, 2003·Medical Teacher·Neal Alexander
Dec 8, 2004·Critical Care Clinics·Beau DuweJohn Hansen-Flaschen
Oct 16, 2012·Nursing in Critical Care·M Rosa Jam GatellJordi Vallés Daunis
Nov 18, 2005·Intensive & Critical Care Nursing : the Official Journal of the British Association of Critical Care Nurses·Mona Wentzel PerseniusMarie-Louise Hall-Lord
Nov 27, 2008·Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition·Cynthia A MillerJanet Madill

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