Positioning the Critically Ill Patient: Evidence and Impact on Nursing Clinical Practice

Abstract

Critically ill patients lay in bed since the beginning of the acute clinical condition. Often they are forced to rest in bed for long periods, due to lifesaving treatments and technologies supporting organ/system failures. Patient repositioning in critical care is strongly linked to the interventional patient hygiene model concerning pressure ulcers, ventilator-associated pneumonia, and immobilization syndrome prevention. At the same time, patient positioning is the antecedent of his/her mobilization and early physiotherapy, which are part of the ABCDE bundle. This chapter discusses the rationales, the evidences, and the contradictions present in medical and nursing scientific literature about patient positioning in critical care units. Moreover, therapeutic advantages and limits for every position are showed. Some technologic support in patient repositioning are described. Lastly, this chapter will provide some suggestions for the repositioning of hemodynamically unstable patients. The main message of this chapter is that all kinds of patients deserve to be early repositioned, if there are not severe contraindications. However, a reassessment of patients aiming to begin a trial of positioning should be conducted at least every 8 h.