The ICU Bed
Intensive care unit (ICU) patients can develop a variety of complications related to prolonged immobilization and recumbent positioning while in the ICU, and, increasingly, obese patients present a number of specific challenges. ICU beds have a common set of capabilities, and a variety of specialty ICU beds have been developed for specific patient populations (Figure 2-1) including patients at risk for decubitus ulcers, obese patients, patients with fractures. A standard ICU bed typically has electric and manual controls, side rails, wheels and a brake, a removable headboard to allow procedures (ie, endotracheal intubation, vascular access) from the head of the bed, and intravenous (IV) pole mounts.
- ▪ Trendelenburg position: Bed position in which the head is lower than the feet—typically used to increase venous return to the heart in hypovolemic shock or to distend blood vessels superior to the heart during venous access procedures (Figure 2-2).
- ▪ Reverse Trendelenburg position: Used in the ICU to elevate the head above the heart to diminish venous return, or to decrease the likelihood of passive regurgitation of gastric contents in patient in whom leg flexion is contraindicated (ie, following femoral arterial cannulation).
- ▪ Elevated head of bed (also known as Fowler or semi-Fowler position): Standard nursing position in an ICU patient, where not otherwise contraindicated—used as one element of the “bundle” of interventions designed to reduce the incidence of ventilator associated pneumonia, by lowering the risk of passive aspiration of gastric contents (Figure 2-3).
- ▪ Decubitus ulcer: Skin ulceration caused by prolonged pressure on a vulnerable area (ie, sacrum, occiput), typically in a bed-ridden patient.
- ▪ Rotation therapy: An approach to the prevention of pulmonary complications and decubitus ulcers by continuously rotating the entire patient.
- ▪ Percussion therapy: An approach to the prevention of ICU complications by continuous bed vibration intended to facilitate the mobilization of pulmonary secretions.
- ▪ Pressure relief therapy: A variety of approaches to the redistribution of weight away from vulnerable pressure points—designed to prevent or treat decubitus ulcers (Figure 2-4).