A 74-year-old woman is brought to the emergency department after being found unconscious at home. She was in ventricular fibrillation and received defibrillation followed by tracheal intubation. EKG showed no ST-segment elevation and cardiac enzymes were negative. She was subsequently admitted to the intensive care unit.
Examination shows clear lung fields and regular first and second heart sounds. The abdomen is soft and nontender. The patient withdraws her extremities to painful stimuli but does not follow commands.
Chest-x ray shows no abnormalities.
Which of the following is the most effective strategy to decrease this patient's risk for developing ventilator-associated pneumonia?

Question

A 74-year-old woman is brought to the emergency department after being found unconscious at home.  She was in ventricular fibrillation and received defibrillation followed by tracheal intubation.  EKG showed no ST-segment elevation and cardiac enzymes were negative.  She was subsequently admitted to the intensive care unit.
Examination shows clear lung fields and regular first and second heart sounds.  The abdomen is soft and nontender.  The patient withdraws her extremities to painful stimuli but does not follow commands.
Chest-x ray shows no abnormalities.
Which of the following is the most effective strategy to decrease this patient's risk for developing ventilator-associated pneumonia?

Quizplus · Accepted Answer

11ec193a_9718_91a7_853d_6d7966086ac9_MD0002_00 Ventilator-associated pneumonia (VAP) worsens patient outcome and poses a burden on the health care system. General measures such as hand hygiene and the use of noninvasive ventilation can minimize VAP. Sedation and weaning protocols decrease time on the ventilator and the risk of VAP. The use of orogastric rather than nasogastric tubes decreases the incidence of sinusitis and VAP. Minimizing aspiration decreases the incidence of VAP. Positioning patients at 30°-45° and maintaining an internal cuff pressure on the endotracheal tube of > 20 cm H₂0 decreases the aspiration of gastric contents (Choice E). Reducing oropharyngeal colonization with oral antiseptics and continuous aspiration of subglottic secretions also decreases the risk of VAP. (Choice A) Early tracheostomy (< 7days) does not reduce the risk of VAP or mortality. (Choice C) Routine prophylaxis with antibiotics is not recommended as it promotes the development of drug-resistant organisms. (Choice D) The use of proton pump inhibitors and histamine receptor-blocking agents is associated with an increased risk of VAP due to increase in gastric pH. Use of these agents should be avoided if possible. Educational objective: The incidence of ventilator-associated pneumonia (VAP) can be decreased with semirecumbent positioning, oral antiseptics, and avoiding proton pump inhibitors and histamine receptor-blocking agents. Routine antibiotic prophylaxis for VAP is not recommended due to development of drug-resistant organisms. __________ References: Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia. (http://www.ncbi.nlm.nih.gov/pubmed/15699079) Measures to prevent nosocomial infections during mechanical ventilation. (http://www.ncbi.nlm.nih.gov/pubmed/22186217)

A 74-Year-Old Woman Is Brought to the Emergency Department After