FEATURES: ORIGINAL INVESTIGATIONSProxy Study on Minimizing Risk of Sacral Pressure Ulcers While Complying with Ventilator-Associated Pneumonia Risk Reduction GuidelinesCrane, Barbara A. PhD, PT; Wininger, Michael PhD; Kunsman, Michelle PT, DPTAuthor Information Barbara A. Crane, PhD, PT, is an Associate Professor in the Department of Rehabilitation Sciences at the University of Hartford, West Hartford, Connecticut. Michael Wininger, PhD, is an Assistant Professor in the Department of Rehabilitation Sciences at the University of Hartford, West Hartford, Connecticut; and Statistician of Medicine, Cooperative Studies Program at the Veterans Affairs Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, Connecticut. Michelle Kunsman, PT, DPT, is an Assistant Professor in the Department of Rehabilitation Sciences at the University of Hartford, West Hartford, Connecticut. The authors have disclosed that they have no financial relationships related to this article. Acknowledgments: This study was supported by the University of Hartford, College of Education, Nursing and Health Professions, Institute for Translational Research, Hartford, Connecticut. Funds were used to purchase pressure mapping equipment and reimburse subjects. Submitted June 24, 2014; accepted in revised form October 21, 2014. Advances in Skin & Wound Care: December 2015 - Volume 28 - Issue 12 - p 541-550 doi: 10.1097/01.ASW.0000471877.19459.85 Buy Metrics Abstract Bed positioning poses a subtle, yet important, tradeoff in the competing needs of hospitalized patients, particularly those susceptible to lower respiratory tract infections and/or pressure ulcers. Although it is widely held that a minimum 30° incline is necessary to mitigate risk of ventilator-acquired pneumonia, it is unclear what effect semirecumbent positioning has on the risk of pressure ulcerations. The authors test several hypotheses with the objective of elucidating the relationship between bed incline, posture, and incline, pursuant to a more evidence-based recommendation for practice in clinical care. To this end, interfacial pressures from 40 healthy subjects were analyzed following observation in both supine and sidelying positions, at shallow (30°) and moderate (45°) bed-angle incline. Summarily, the authors report that supine postures reduce pressure signatures associated with pressure ulceration versus sidelying position: 15% increase area of contact (P = 1.3×10-5), and 17% decrease in ratio of peak to average pressure (P = 3.1×10-3). Within supine posture, the authors found significant increases in 4 measures of local pressure, including average pressure (10.4% decrease, P = .005) and coefficient of pressure variation (22.1%, P = 2.2×10-4) at moderate incline. The authors conclude that supine bed positionings at moderate incline appear to reduce predictors of pressure ulceration. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.