Skip to main content
SpringerLink
Log in

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

  • Chapter
  • First Online:
Nursing in Critical Care Setting

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

References

  1. Hawkins S, Stone K, Plummer L. An holistic approach to turning patients. Nurs Stand. 1999;6-12:51–6. https://doi.org/10.7748/ns1999.10.14.3.51.c2689.

  2. Truong AD, Fan E, Brower RG, Needham DM. Bench-to-bedside review: mobilizing patients in the intensive care unit-from pathophysiology to clinical trials. Crit Care. 2009;13:216. https://doi.org/10.1186/cc7885.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Johnson KL, Meyenburg T. Physiological rationale and current evidence for therapeutic positioning of critically ill patients. AACN Adv Crit Care. 2009;20:228–40. https://doi.org/10.1097/NCI.0b013e3181add8db.

    Article  PubMed  Google Scholar 

  4. Goldhill DR, Imhoff M, McLean B, Waldmann C. Rotational bed therapy to prevent and treat respiratory complications: a review and meta-analysis. Am J Crit Care. 2007;16:50–61.

    PubMed  Google Scholar 

  5. Corcoran PJ. Use it or lose it-the hazards of bed rest and inactivity. West J Med. 1991;154:536–8.

    PubMed  PubMed Central  CAS  Google Scholar 

  6. Thomas PJ, Paratz JD, Stanton WR, Deans R, Lipman J. Positioning practices for ventilated intensive care patients: current practice, indications and contraindications. Aust Crit Care. 2006;19:122–6, 128, 130-2.

    Article  PubMed  Google Scholar 

  7. Hagisawa S, Ferguson-Pell M. Evidence supporting the use of two-hourly turning for pressure ulcer prevention. J Tissue Viability. 2008;17:76–81. https://doi.org/10.1016/j.jtv.2007.10.001.

    Article  PubMed  Google Scholar 

  8. Defloor T, De Bacquer D, Grypdonck MH. The effect of various combinations of turning and pressure reducing devices on the incidence of pressure ulcers. Int J Nurs Stud. 2005;42:37–46. https://doi.org/10.1016/j.ijnurstu.2004.05.013.

    Article  PubMed  Google Scholar 

  9. Krishnagopalan S, Johnson EW, Low LL, Kaufman LJ. Body positioning of intensive care patients: clinical practice versus standards. Crit Care Med. 2002;30:2588–92. https://doi.org/10.1097/01.CCM.0000034455.71412.8C.

    Article  PubMed  Google Scholar 

  10. Voz A, Williams C, Wilson M. Who is turning the patients? A survey study. J Wound Ostomy Continence Nurs. 2011;38:413–8. https://doi.org/10.1097/WON.0b013e318220b6ec.

    Article  PubMed  Google Scholar 

  11. Tayyib N, Lewis PA, Coyer FM. A prospective observational study of patient positioning in a Saudi intensive care unit. MEJN. 2013;7:26–34.

    Article  Google Scholar 

  12. Goldhill DR, Badacsonyi A, Goldhill AA, Waldmann C. A prospective observational study of ICU patient position and frequency of turning. Anaesthesia. 2008;63:509–15. https://doi.org/10.1111/j.1365-2044.2007.05431.x.

    Article  PubMed  CAS  Google Scholar 

  13. Fink KC. Is Trendelenburg a wise choice? J Emerg Nurs. 1999;25:60–2.

    Article  CAS  PubMed  Google Scholar 

  14. Geerts BF, van den Bergh L, Stijnen T, Aarts LP, Jansen JR. Comprehensive review: is it better to use the Trendelenburg position or passive leg raising for the initial treatment of hypovolemia? J Clin Anesth. 2012;24:668–74. https://doi.org/10.1016/j.jclinane.2012.06.003.

    Article  PubMed  Google Scholar 

  15. Grap MJ, Munro CL, Bryant S, Ashtiani B. Predictors of backrest elevation in critical care. Intensive Crit Care Nurs. 2003;19:68–74.

    Article  PubMed  Google Scholar 

  16. Hiner C, Kasuya T, Cottingham C, Whitney J. Clinicians' perception of head-of-bed elevation. Am J Crit Care. 2010;19:164–7. https://doi.org/10.4037/ajcc2010917.

    Article  PubMed  Google Scholar 

  17. Wolken RF, Woodruff RJ, Smith J, Albert RK, Douglas IS. Observational study of head of bed elevation adherence using a continuous monitoring system in a medical intensive care unit. Respir Care. 2012;57:537–43. https://doi.org/10.4187/respcare.01453.

    Article  PubMed  Google Scholar 

  18. Rose L, Baldwin I, Crawford T. The use of bed-dials to maintain recumbent positioning for critically ill mechanically ventilated patients (The RECUMBENT study): multicentre before and after observational study. Int J Nurs Stud. 2010;47:1425–31. https://doi.org/10.1016/j.ijnurstu.2010.04.002.

    Article  PubMed  Google Scholar 

  19. Deye N, Lellouche F, Maggiore SM, Taillé S, Demoule A, L’Her E, et al. The semi-seated position slightly reduces the effort to breathe during difficult weaning. Intensive Care Med. 2013;39:85–92. https://doi.org/10.1007/s00134-012-2727-5.

    Article  PubMed  CAS  Google Scholar 

  20. Thomas P, Paratz J, Lipman J. Seated and semi-recumbent positioning of the ventilated intensive care patient - effect on gas exchange, respiratory mechanics and hemodynamics. Heart Lung. 2014;43:105–11. https://doi.org/10.1016/j.hrtlng.2013.11.011.

    Article  PubMed  Google Scholar 

  21. Driscoll A, Shanahan A, Crommy L, Foong S, Gleeson A. The effect of patient position on the reproducibility of cardiac output measurements. Heart Lung. 1995;24:38–44.

    Article  CAS  PubMed  Google Scholar 

  22. Göcze I, Strenge F, Zeman F, Creutzenberg M, Graf BM, Schlitt HJ, et al. The effects of the semirecumbent position on hemodynamic status in patients on invasive mechanical ventilation: prospective randomized multivariable analysis. Crit Care. 2013;17:R80. https://doi.org/10.1186/cc12694.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Daihua Y, Wei C, Xude S, Linong Y, Changjun G, Hui Z. The effect of body position changes on stroke volume variation in 66 mechanically ventilated patients with sepsis. J Crit Care. 2012;27:416.e7–12. https://doi.org/10.1016/j.jcrc.2012.02.009.

    Article  Google Scholar 

  24. Peterson M, Schwab W, McCutcheon K, van Oostrom JH, Gravenstein N, Caruso L. Effects of elevating the head of bed on interface pressure in volunteers. Crit Care Med. 2008;36:3038–42. https://doi.org/10.1097/CCM.0b013e31818b8dbd.

    Article  PubMed  CAS  Google Scholar 

  25. Behrendt R, Ghaznavi AM, Mahan M, Craft S, Siddiqui A. Continuous bedside pressure mapping and rates of hospital-associated pressure ulcers in a medical intensive care unit. Am J Crit Care. 2014;23:127–33. https://doi.org/10.4037/ajcc2014192.

    Article  PubMed  Google Scholar 

  26. Reilly ER, Karakousis GC, Schrag SP, Stawicki SP. Pressure ulcers in the intensive care unit: the ‘forgotten’ enemy. OPUS 12. Scientist. 2007;1:17–30.

    Article  Google Scholar 

  27. Burk RS, Grap MJ. Backrest position in prevention of pressure ulcers and ventilator-associated pneumonia: conflicting recommendations. Heart Lung. 2012;41:536–45. https://doi.org/10.1016/j.hrtlng.2012.05.008.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Niël-Weise BS, Gastmeier P, Kola A, Vonberg RP, Wille JC, van den Broek PJ, et al. An evidence-based recommendation on bed head elevation for mechanically ventilated patients. Crit Care. 2011;15:R111. https://doi.org/10.1186/cc10135.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Marklew A. Body positioning and its effect on oxygenation--a literature review. Nurs Crit Care. 2006;11:16–22.

    Article  PubMed  Google Scholar 

  30. Mauri T, Berra L, Kumwilaisak K, Pivi S, Ufberg JW, Kueppers F, et al. Lateral-horizontal patient position and horizontal orientation of the endotracheal tube to prevent aspiration in adult surgical intensive care unit patients: a feasibility study. Respir Care. 2010;55:294–302.

    PubMed  Google Scholar 

  31. Thomas PJ, Paratz JD, Lipman J, Stanton WR. Lateral positioning of ventilated intensive care patients: a study of oxygenation, respiratory mechanics, hemodynamics, and adverse events. Heart Lung. 2007;36:277–86. https://doi.org/10.1016/j.hrtlng.2006.10.008.

    Article  PubMed  Google Scholar 

  32. Hewitt N, Bucknall T, Faraone NM. Lateral positioning for critically ill adult patients. Cochrane Database Syst Rev 2016, Issue 5. Art. No.: CD007205. DOI:https://doi.org/10.1002/14651858.CD007205.pub2.

  33. Kim MJ, Hwang HJ, Song HH. A randomized trial on the effects of body positions on lung function with acute respiratory failure patients. Int J Nurs Stud. 2002;39:549–55.

    Article  PubMed  Google Scholar 

  34. Tongyoo S, Vilaichone W, Ratanarat R, Permpikul C. The effect of lateral position on oxygenation in ARDS patients: a pilot study. J Med Assoc Thail. 2006;89:S55–61.

    Google Scholar 

  35. Banasik JL, Emerson RJ. Effect of lateral positions on tissue oxygenation in the critically ill. Heart Lung. 2001;30:269–7895. https://doi.org/10.1067/mhl.2001.116012.

    Article  PubMed  CAS  Google Scholar 

  36. Jones AY, Dean E. Body position change and its effect on hemodynamic and metabolic status. Heart Lung. 2004;33:281–90.

    Article  PubMed  Google Scholar 

  37. Peterson MJ, Schwab W, van Oostrom JH, Gravenstein N, Caruso LJ. Effects of turning on skin-bed interface pressures in healthy adults. J Adv Nurs. 2010;66:1556–64. https://doi.org/10.1111/j.1365-2648.2010.05292.x.

    Article  PubMed  Google Scholar 

  38. Henderson WR, Griesdale DE, Dominelli P, Ronco JJ. Does prone positioning improve oxygenation and reduce mortality in patients with acute respiratory distress syndrome? Can Respir J. 2014;21:213–5.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Senecal PA. Prone position for Acute Respiratory Distress Syndrome. Crit Care Nurse. 2015;35:72. https://doi.org/10.4037/ccn2015990.

    Article  PubMed  Google Scholar 

  40. Bloomfield R, Noble DW, Sudlow A. Prone position for acute respiratory failure in adults. Cochrane Database Syst Rev 2015, Issue 11. Art. No.: CD008095. DOI:https://doi.org/10.1002/14651858.CD008095.pub2.

  41. Taccone P, Pesenti A, Latini R, Polli F, Vagginelli F, Mietto C, et al. Prone positioning in patients with moderate and severe acute respiratory distress syndrome: a randomized controlled trial. JAMA. 2009;302:1977–84. https://doi.org/10.1001/jama.2009.1614.

    Article  PubMed  CAS  Google Scholar 

  42. Lucchini A, Pelucchi G, Gariboldi R, Vimercati S, Brambilla D, Elli S, et al. Prone position in patients with acute lung injury. Scenario. 2010;27:23–8.

    Google Scholar 

  43. Goettler CE, Pryor JP, Hoey BA, Phillips JK, Balas MC, Shapiro MB. Prone positioning does not affect cannula function during extracorporeal membrane oxygenation or continuous renal replacement therapy. Crit Care. 2002;6:452–5.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Maillet JM, Thierry S, Brodaty D. Prone positioning and acute respiratory distress syndrome after cardiac surgery: a feasibility study. J Cardiothorac Vasc Anesth. 2008;22:414–7. https://doi.org/10.1053/j.jvca.2007.10.013.

    Article  PubMed  Google Scholar 

  45. Michelet P, Roch A, Gainnier M, Sainty JM, Auffray JP, Papazian L. Influence of support on intra-abdominal pressure, hepatic kinetics of indocyanine green and extravascular lung water during prone positioning in patients with ARDS: a randomized crossover study. Crit Care. 2005 Jun;9:R251–7. https://doi.org/10.1186/cc3513.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Robak O, Schellongowski P, Bojic A, Laczika K, Locker GJ, Staudinger T. Short-term effects of combining upright and prone positions in patients with ARDS: a prospective randomized study. Crit Care. 2011;15:R230. https://doi.org/10.1186/cc10471.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Romero CM, Cornejo RA, Gálvez LR, Llanos OP, Tobar EA, Berasaín MA, et al. Extended prone position ventilation in severe acute respiratory distress syndrome: a pilot feasibility study. J Crit Care. 2009;24:81–8. https://doi.org/10.1016/j.jcrc.2008.02.005.

    Article  PubMed  Google Scholar 

  48. Oczenski W, Hörmann C, Keller C, Lorenzl N, Kepka A, Schwarz S, et al. Recruitment maneuvers during prone positioning in patients with acute respiratory distress syndrome. Crit Care Med. 2005;33:54–61.

    Article  PubMed  Google Scholar 

  49. Scaravilli V, Grasselli G, Castagna L, Zanella A, Isgrò S, Lucchini A, et al. Prone positioning improves oxygenation in spontaneously breathing nonintubated patients with hypoxemic acute respiratory failure: A retrospective study. J Crit Care. 2015;30:1390–4. https://doi.org/10.1016/j.jcrc.2015.07.008.

    Article  PubMed  Google Scholar 

  50. Reignier J, Thenoz-Jost N, Fiancette M, Legendre E, Lebert C, Bontemps F, et al. Early enteral nutrition in mechanically ventilated patients in the prone position. Crit Care Med. 2004;32:94–9. https://doi.org/10.1097/01.CCM.0000104208.23542.A8.

    Article  PubMed  Google Scholar 

  51. Reignier J, Dimet J, Martin-Lefevre L, Bontemps F, Fiancette M, Clementi E, et al. Before-after study of a standardized ICU protocol for early enteral feeding in patients turned in the prone position. Clin Nutr. 2010;29:210–6. https://doi.org/10.1016/j.clnu.2009.08.004.

    Article  PubMed  Google Scholar 

  52. Reinprecht A, Greher M, Wolfsberger S, Dietrich W, Illievich UM, Gruber A. Prone position in subarachnoid hemorrhage patients with acute respiratory distress syndrome: effects on cerebral tissue oxygenation and intracranial pressure. Crit Care Med. 2003;31:1831–8. https://doi.org/10.1097/01.CCM.0000063453.93855.0A.

    Article  PubMed  Google Scholar 

  53. Nekludov M, Bellander BM, Mure M. Oxygenation and cerebral perfusion pressure improved in the prone position. Acta Anaesthesiol Scand. 2006;50:932–6. https://doi.org/10.1111/j.1399-6576.2006.01099.x.

    Article  PubMed  CAS  Google Scholar 

  54. Roth C, Ferbert A, Deinsberger W, Kleffmann J, Kästner S, Godau J, et al. Does prone positioning increase intracranial pressure? A retrospective analysis of patients with acute brain injury and acute respiratory failure. Neurocrit Care. 2014;21:186–91. https://doi.org/10.1007/s12028-014-0004-x.

    Article  PubMed  Google Scholar 

  55. Defloor T. The effect of position and mattress on interface pressure. Appl Nurs Res. 2000;13:2–11.

    Article  CAS  PubMed  Google Scholar 

  56. Lippoldt J, Pernicka E, Staudinger T. Interface pressure at different degrees of backrest elevation with various types of pressure-redistribution surfaces. Am J Crit Care. 2014;23:119–26. https://doi.org/10.4037/ajcc2014670.

    Article  PubMed  Google Scholar 

  57. Still MD, Cross LC, Dunlap M, Rencher R, Larkins ER, Carpenter DL, et al. The turn team: a novel strategy for reducing pressure ulcers in the surgical intensive care unit. J Am Coll Surg. 2013;216:373–9. https://doi.org/10.1016/j.jamcollsurg.2012.12.001.

    Article  PubMed  Google Scholar 

  58. Lewandowski L, Lewandowski M. Intensive care in the obese. Best Pract Res Clin Anaesthesiol. 2011;25:95–108.

    Article  PubMed  Google Scholar 

  59. Tsueda K, Debrand M, Zeok SS, Wright BD, Griffin WO. Obesity supine death syndrome: reports of two morbidly obese patients. Anesth Analg. 1979;58:345–7.

    Article  CAS  PubMed  Google Scholar 

  60. Charlebois D, Wilmoth D. Critical Care of Patients With Obesity. Crit Care Nurse. 2004;24:19–27.

    PubMed  Google Scholar 

  61. Lemyze M, Mallat J, Duhamel A, Pepy F, Gasan G, Barrailler S, et al. Effects of sitting position and applied positive end-expiratory pressure on respiratory mechanics of critically ill obese patients receiving mechanical ventilation*. Crit Care Med. 2013;41:2592–9. https://doi.org/10.1097/CCM.0b013e318298637f.

    Article  PubMed  Google Scholar 

  62. De Jong A, Molinari N, Sebbane M, Prades A, Futier E, Jung B, et al. Feasibility and effectiveness of prone position in morbidly obese patients with ARDS: a case-control clinical study. Chest. 2013;143:1554–61. https://doi.org/10.1378/chest.12-2115.

    Article  PubMed  Google Scholar 

  63. Bambi S, Ruggeri M, Becattini G, Lumini E. Bariatric patients in emergency department: a challenge for nursing care. Scenario. 2013;30:4–15.

    Google Scholar 

  64. Fragala G. Facilitating repositioning in bed. AAOHN J. 2011;59:63–8. https://doi.org/10.3928/08910162-20110117-01.

    Article  PubMed  Google Scholar 

  65. Groah SL, Schladen M, Pineda CG, Hsieh CH. Prevention of pressure ulcers among people with spinal cord injury: a systematic review. PMR. 2015;7:613–36. https://doi.org/10.1016/j.pmrj.2014.11.014.

    Article  Google Scholar 

  66. Gutierrez CJ, Stevens C, Merritt J, Pope C, Tanasescu M, Curtiss G. Trendelenburg chest optimization prolongs spontaneous breathing trials in ventilator-dependent patients with low cervical spinal cord injury. J Rehabil Res Dev. 2010;47:261–72.

    Article  PubMed  Google Scholar 

  67. Guervilly C, Hraiech S, Gariboldi V, Xeridat F, Dizier S, Toesca R, et al. Prone positioning during veno-venous extracorporeal membrane oxygenation for severe acute respiratory distress syndrome in adults. Minerva Anestesiol. 2014;80:307–13.

    PubMed  CAS  Google Scholar 

  68. Culbreth RE, Goodfellow LT. Complications of Prone Positioning During Extracorporeal Membrane Oxygenation for Respiratory Failure: A Systematic Review. Respir Care. 2016;61:249–54. https://doi.org/10.4187/respcare.03882.

    Article  PubMed  Google Scholar 

  69. Cheatham ML, De Waele JJ, De Laet I, De Keulenaer B, Widder S, Kirkpatrick AW, et al. The impact of body position on intra-abdominal pressure measurement: a multicenter analysis. Crit Care Med. 2009;37:2187–90. https://doi.org/10.1097/CCM.0b013e3181a021fa.

    Article  PubMed  Google Scholar 

  70. Yi M, Leng Y, Bai Y, Yao G, Zhu X. The evaluation of the effect of body positioning on intra-abdominal pressure measurement and the effect of intra-abdominal pressure at different body positioning on organ function and prognosis in critically ill patients. J Crit Care. 2012;27:222.e1–6. https://doi.org/10.1016/j.jcrc.2011.08.010.

    Article  Google Scholar 

  71. Barwing J, Pedroni C, Quintel M, Moerer O. Influence of body position, PEEP and intra-abdominal pressure on the catheter positioning for neurally adjusted ventilatory assist. Intensive Care Med. 2011;37:2041–5. https://doi.org/10.1007/s00134-011-2373-3.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Khir AW, Price S, Hale C, Young DA, Parker KH, Pepper JR. Intra-aortic balloon pumping: does posture matter? Artif Organs. 2005;29:36–40. https://doi.org/10.1111/j.1525-1594.2004.29013.x.

    Article  PubMed  Google Scholar 

  73. Chang AT, Boots RJ, Hodges PW, Thomas PJ, Paratz JD. Standing with the assistance of a tilt table improves minute ventilation in chronic critically ill patients. Arch Phys Med Rehabil. 2004;85:1972–6.

    Article  PubMed  Google Scholar 

  74. Hongrattana G, Reungjui P, Jones CU. Acute hemodynamic responses to 30° head-down postural drainage in stable, ventilated trauma patients: a randomized crossover trial. Heart Lung. 2014;43:399–405. https://doi.org/10.1016/j.hrtlng.2014.01.011.

    Article  PubMed  Google Scholar 

  75. Lizy C, Swinnen W, Labeau S, Poelaert J, Vogelaers D, Vandewoude K, et al. Cuff pressure of endotracheal tubes after changes in body position in critically ill patients treated with mechanical ventilation. Am J Crit Care. 2014;23:e1–8. https://doi.org/10.4037/ajcc2014489.

    Article  PubMed  Google Scholar 

  76. Chao YF, Chen YY, Wang KW, Lee RP, Tsai H. Removal of oral secretion prior to position change can reduce the incidence of ventilator-associated pneumonia for adult ICU patients: a clinical controlled trial study. J Clin Nurs. 2009;18:22–8. https://doi.org/10.1111/j.1365-2702.2007.02193.x.

    Article  PubMed  Google Scholar 

  77. Cooke M, Chaboyer W, Schluter P, Foster M, Harris D, Teakle R. The effect of music on discomfort experienced by intensive care unit patients during turning: a randomized cross-over study. Int J Nurs Pract. 2010;16:125–31. https://doi.org/10.1111/j.1440-172X.2010.01819.x.

    Article  PubMed  Google Scholar 

  78. Ahrens T, Kollef M, Stewart J, Shannon W. Effect of kinetic therapy on pulmonary complications. Am J Crit Care. 2004;13:376–83.

    PubMed  Google Scholar 

  79. Ambrosino N, Janah N, Vagheggini G. Physiotherapy in critically ill patients. Rev Port Pneumol. 2011;17(6):283–8. https://doi.org/10.1016/j.rppneu.2011.06.004.

    Article  PubMed  CAS  Google Scholar 

  80. Delaney A, Gray H, Laupland KB, Zuege DJ. Kinetic bed therapy to prevent nosocomial pneumonia in mechanically ventilated patients: a systematic review and meta-analysis. Crit Care. 2006;10:R70. https://doi.org/10.1186/cc4912.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Prasarn ML, Horodyski M, Behrend C, Del Rossi G, Dubose D, Rechtine GR. Is it safe to use a kinetic therapy bed for care of patients with cervical spine injuries? Injury. 2015;46:388–91. https://doi.org/10.1016/j.injury.2014.10.049.

    Article  PubMed  Google Scholar 

  82. Hamlin SK, Hanneman SK, Padhye NS, Lodato RF. Hemodynamic changes with manual and automated lateral turning in patients receiving mechanical ventilation. Am J Crit Care. 2015;24:131–40. https://doi.org/10.4037/ajcc2015782.

    Article  PubMed  Google Scholar 

  83. Swadener-Culpepper L. Continuous lateral rotation therapy. Crit Care Nurse. 2010;30:S5–7. https://doi.org/10.4037/ccn2010766.

    Article  PubMed  Google Scholar 

  84. Brindle CT, Malhotra R, Oʼrourke S, Currie L, Chadwik D, Falls P, et al. Turning and repositioning the critically ill patient with hemodynamic instability: a literature review and consensus recommendations. J Wound Ostomy Continence Nurs. 2013;40:254–67. https://doi.org/10.1097/WON.0b013e318290448f.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Emergency & Trauma ICU, University Hospital Careggi, Florence, Italy

    Stefano Bambi R.N., B.S., M.A.S., O.N.N.-C.G.

  2. General Intensive Care Unit, San Gerardo Hospital, ASST Monza, Monza, Italy

    Stefano Elli R.N.

Authors
  1. Stefano Bambi R.N., B.S., M.A.S., O.N.N.-C.G.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stefano Elli R.N.
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Bambi, S., Elli, S. (2018). Positioning the Critically Ill Patient: Evidence and Impact on Nursing Clinical Practice. In: Nursing in Critical Care Setting. Springer, Cham. https://doi.org/10.1007/978-3-319-50559-6_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-50559-6_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-50558-9

  • Online ISBN: 978-3-319-50559-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation