• Mary Jo Grap, Cindy L Munro, Christine M Schubert, Paul A Wetzel, Ruth S Burk, Anathea Pepperl, and Valentina Lucas.
• Mary Jo Grap is Nursing Alumni Distinguished Professor and Ruth S. Burk is an assistant professor, Adult Health and Nursing Systems Department, School of Nursing, Paul A. Wetzel is an associate professor and Anathea Pepperl is an assistant professor, Biomedical Engineering Department, School of Engineering, Virginia Commonwealth University, Richmond, Virginia. Valentina Lucas is a nurse practitioner, Department of Surgery, Virginia Commonwealth University Health System, Richmond, Virginia. Cindy L. Munro is dean and professor, School of Nursing and Health Studies, University of Miami, Coral Gables, Florida. Christine M. Schubert is an associate professor, Department of Mathematics and Statistics, Air Force Institute of Technology, Wright-Patterson Air Force Base, Dayton, Ohio. mjgrap@vcu.edu.
• Am. J. Crit. Care. 2018 Mar 1; 27 (2): 104-113.

BackgroundAlthough higher backrest elevation may be a theoretical risk for integrity of sacral tissues, few data support use of high backrest elevation.ObjectiveTo describe the effect of backrest elevation on the integrity of sacral tissue in critically ill adults receiving mechanical ventilation.MethodsPatients from 3 critical care units (surgical trauma, medical respiratory, and neuroscience) who were expected to have mechanical ventilation for at least 24 hours were intubated and mechanical ventilation was started. Participants were enrolled in the study within 24 hours of intubation. Backrest elevation was continuously measured by using mechanical system- based accelerometers. Integrity of sacral tissue was evaluated by using high-frequency sonography.ResultsData for 84 patients who had measurements of both backrest elevation and skin integrity were available for analysis. General linear models indicated no significant difference among the proportions of time spent at less than 20° (P values: .57 the first 24 hours, .17 the first 48 hours, .81 the first 72 hours), 20° to 30° (P values: .25 the first 24 hours, .08 the first 48 hours, .25 the first 72 hours), or greater than 30° (P values: .62 the first 24 hours, .28 the first 48 hours, .68 the first 72 hours) among participants with no injury, no change in injury, improvement in injury, or injury that worsened.ConclusionsLevel of backrest elevation is not associated with changes in tissue integrity. Body positioning in critically ill patients receiving mechanical ventilation may not be as important or as effective as once thought.©2018 American Association of Critical-Care Nurses.

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