Keeping backrest elevations low has been recommended to reduce the risk of pressure injury in critically ill patients receiving mechanical ventilation. However, higher backrest positions are recommended to reduce the risk of ventilator-associated pneumonia. Researchers conducted a descriptive longitudinal study to evaluate the effect of backrest elevation on the integrity of sacral tissue in critically ill adults receiving mechanical ventilation.

Patients from three critical care units who were expected to receive mechanical intubation for at least 24 hours, including those who had an existing pressure injury, were enrolled in the study within 24 hours of intubation. Backrest elevation was continuously monitored using microelectromechanical system-based accelerometers, and sacral tissue integrity was assessed by high-frequency ultrasonography.

Data on 84 patients who had measurements of both backrest elevation and skin integrity were included in the analysis. During the first 72 hours, most patients had either no injury or an existing injury that did not change. No significant difference was found in the proportions of time spent at less than 20[degrees], 20[degrees] to 30[degrees], or greater than 30[degrees] among patients with no injury, no change in injury, improvement in injury, or worsening of injury.

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