Heads of beds in ICU? Use your own head, guideline critiquers say

A systematic review of 3 trials (n=337) by the Bed Head Elevation Study Group (not to be confused with the Bedhead photo group) found no good evidence that head-of-bed (HOB) elevation to 45' helps or harms in any way (pneumonia, decubiti, mortality, VTE, or hemodynamic instability). Nevertheless, a consensus panel of 22 experts agrees with previous recommendations in the Institute for Health Care Improvement's ventilator bundle: elevate the HOB to 30' if there is no good reason not to. There is some evidence that the ventilator bundle in toto may reduce the rate of ventilator-associated pneumonia. Critical Care 2011;15:R111 FULL FREE TEXT