Intensive Care Unit patients suffer the risk of losing their lives due to the critical illnesses they suffer from and ventilator-associated infections contracted while under special care, such as nosocomial pneumonia. The infection affects 27% of the patients and medical experts rate it as one of the most common pneumonia infections (Marti & Ewig, 2009). Over eighty-six percent of ICU related pneumonia cases are as a result of mechanical ventilation. The cases are, usually, higher in different populations, for example, those reported in United States range from 250,000 to 300,000 per year.
The picot question is “In mechanically ventilated ICU patients, does positioning of the patient in semi-fowlers position result in a lower incidence of nosocomial pneumonia when compared to the supine position?”
Nosocomial pneumonia being a secondary process infects intubated patients under mechanical ventilation and occurs after a period of 48hours. Measures to counter the infection include respiratory secretions analysis, high levels of clinical supervision and patient bedside examination (Baughman, 2009). Through the study of the pathogens, clinical experts have known more about the infection how to manage it. The infections diagnosis includes; clinical, radiologic and microbiologic analysis.
Overtreatment and under treatment cases are experienced when dealing with the infection. Poor positive predictive value and specificity are some of the factors that lead to overtreatment while under-treatment results from over-reliance on clinical diagnosis (MacIntyre & Branson, 2009). Bed rest positions, for example, semi-fowler and supine are also associated with nosocomial pneumonia. Comparing the two bed rest techniques, semi- fowlers result in a lower infection incidence than the supine position.
Semi-fowlers position involves resting the patients head between a 45 to 60 degrees angle. The position enables proper breathing by allowing maximum chest expansion and abdominal muscle relaxation. Supine position involves the ill patient lying with the face up (Marti & Ewig, 2011). Such patients tend to experience less ventilation and perfusion in the anterior parts of their lungs compared to the dependent parts.
PICOT refers to acronym for the elements that make up the clinical question. The elements are population (p), intervention (I), comparison (C), outcome (O), and time (T). In this case the elements represented below match the picot format as follows:
- P: mechanically ventilated ICU patients
- I: semi-fowlers position
- C: supine position
- O: lower nosocomial pneumonia incidence
- T: Duration at the ICU
- Population: Over eighty-six percent of ICU related pneumonia cases are linked to mechanical ventilation (MacIntyre & Branson, 2009). In the United States, a thousand hospital patient admissions register incidence rates of between 5 to 10 cases with 250,000 to 300,000 reported cases annually. The infection also has a 0 to 50% mortality rates.
- Intervention: Practices done to reduce the infection rates include; raising the patients head to a 30 degrees semi-upright position, oral hygiene, early mobilization and daily neurologic evaluations (Baughman, 2009).
- Comparison: Between supine and semi-fowlers, patients in semi-fowlers position have a lower incidence of nosocomial pneumonia. Supine position interferes with the patients perfusion and ventilation.
- Outcome: Semi-fowler bed rest position is recommended for the patients with necessary restrictions even though the trial results do not fully prove it to be effective or harmful (Marti & Ewig, 2011).
- Time: Nosomial pneumonia contraction occurs after 48hours of hospitalization and the results for intervention practices used can be acquired after 24hours.
Patients found to be suffering from nosocomial pneumonia should immediately receive antibiotics. In instances where a patient is already using antibiotics, the nurse should immediately change them and administer another (Baughman, 2009). More supervision should be conducted to patients with deteriorating health conditions to determine if they are suffering from mechanically ventilated nosocomial pneumonia.
Baughman, R. (2009). Contemporary diagnosis and management of nosocomial pneumonia (2nd ed.). Newtown, Pa: Handbooks in Health Care Co.
Macintyre, R., & Branson, R. (2009). Mechanical ventilation (2nd ed.). St. Louis, MO: Saunders Elsevier.
Marti, T., & Ewig, S. (2011). Nosocomial and ventilator-associated pneumonia. Sheffield, United Kingdom: European Respiratory Respiratory Society.