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.
Chart of various specialty beds with applications, costs,
and additional details. Copyright Trustees of the University of
Pennsylvania, with permission.
- ▪ 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
- ▪ 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
- ▪ 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
- ▪ Decubitus ulcer: Skin ulceration caused by prolonged pressure
on a vulnerable area (ie, sacrum, occiput), typically in a bed-ridden
- ▪ Rotation therapy: An approach to the prevention of pulmonary
complications and decubitus ulcers by continuously rotating the
- ▪ 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).
ICU bed with pressure relief mattress and standard controls
in Trendelenburg (head down) position.
ICU bed in Fowler position.
Specialty pressure relief air/fluid mattress,
in which warmed air passes continuously through beads and the mattress
surface, minimizing local skin pressure.
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