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Chapter 19: Healthcare-Acquired Infections

A 46-year-old man with a history of coronary artery disease, hypertension, and diabetes is transferred from the operating room to the ICU after undergoing 3-vessel coronary artery bypass graft. The procedure was complicated by vasodilatory shock requiring pressor support. Additionally, the patient required 2 units of packed red blood cells intraoperatively. He is afebrile and his blood pressure is 100/90 mmHg. His exam is significant for an intubated, sedated male status poststernotomy. All of the following are recommended to prevent the development of ventilator-associated pneumonia except:

A. Utilization of silver-coated endotracheal tubes

B. Elevating the head of the bed to 30° to 45°

C. Interrupting sedation daily

D. Changing the ventilator circuit if it is visibly soiled or malfunctioning

A. Utilization of silver-coated endotracheal tubes

Recommendations for the prevention of VAP include avoidance of intubation when possible; minimizing sedation and, particularly, avoiding benzodiazepines; avoiding daily sedation interruptions (choice C); maintaining and improving physical conditioning with early mobilization and exercise; and assessing readiness to extubate daily; minimizing pooling of secretions above the endotracheal tube cuff by means of endotracheal tubes with subglottic secretion drainage ports and elevating the head of the bed to 30° to 45° (choice B). Current data does not support scheduled replacement of the ventilator circuit but does support changing the ventilator circuit if it is visibly soiled or malfunctioning (choice D). The use of silver-coated endotracheal tubes is generally not recommended. Although silver-coated endotracheal tubes may lower VAP rates, significant data suggests no impact on duration of mechanical ventilation, mortality, or length of stay (choice A).

Regular use of oral care with chlorhexidine in mechanically ventilated patients has been associated with which of the following?

A. Reduced rate of VAP

B. Reduced duration of mechanical ventilation

C. Reduced mortality benefit

D. Lack of benefit in cardiac-surgery patients

A. Reduced rate of VAP

Current evidence suggests that regular oral care with chlorhexidine in intubated patients may lower VAP rates (choice A), but there is insufficient data to determine the impact on duration of mechanical ventilation or mortality (choices B and C). The benefits of oral care with chlorhexidine are particularly pronounced in cardiac surgery patients (choice D).

A 26-year-old man with no significant medical history initially presented to the emergency department (ED) 3 days ago with altered mental status in the setting of opioid overdose. He was intubated in the ED and transferred ...

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