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Question 12#

A 48-year-old man is admitted to your service after an inhalational chemical exposure. He develops respiratory distress and requires endotracheal intubation and mechanical ventilation. Which of the following is the best way to decrease his risk of developing ventilator-acquired pneumonia?

A. a. Daily interruption of sedation to assess respiratory status
B. Nasopharyngeal rather than oropharyngeal endotracheal intubation
C. Institution of protocol to keep bed flat during ventilation
D. Intermittent nasopharyngeal suctioning
E. Prophylactic broad-spectrum intravenous antibiotics

Correct Answer is A

Comment:

Daily interruption of sedation (“sedation holiday”) to assess readiness for extubation has been shown to decrease the risk of ventilator-acquired pneumonia. Oropharyngeal (rather than nasopharyngeal) intubation, elevating the head of the bed (rather than keeping the patient flat), and subglottic secretion suctioning can also decrease ventilator-acquired pneumonia. Nasopharyngeal and gastrointestinal tract bacterial flora modulation via topical or oral antibiotics may also decrease VAP risk, although it is not routinely recommended. Prophylactic intravenous antibiotics are not recommended.