Q: All of the following may decrease the rate of Ventilator Associated Pneumonia (VAP) except?
A) Oral hygiene via chlorhexidine mouthwash or gel
B) Head of bed elevation to reduce subglottic drainage
C) Maintaining an ETT airway cuff pressure to 10 to 20 cm H2O.
D) Minimizing transport out of the ICU
E) Application of 5 to 8 cm H2O of PEEP
Answer: C
All of the above have shown to decrease the rate of VAP, but cuff pressure of ETT should be maintained at 20 to 30 cm H2O.
In above question choice D is an interesting choice, but rationale behind relationship of VAP and Minimizing transport out of the ICU is the observational studies showing bedside resuscitation bags as a source of bacterial contamination.
References:
1. Kollef MH, Von Harz B, Prentice D, et al. Patient transport from intensive care increases the risk of developing ventilator-associated pneumonia. Chest 1997; 112:765.
2. Thompson AC, Wilder BJ, Powner DJ. Bedside resuscitation bags: a source of bacterial contamination. Infect Control 1985; 6:231.
3. Weber DJ, Wilson MB, Rutala WA, Thomann CA. Manual ventilation bags as a source for bacterial colonization of intubated patients. Am Rev Respir Dis 1990; 142:892.
A) Oral hygiene via chlorhexidine mouthwash or gel
B) Head of bed elevation to reduce subglottic drainage
C) Maintaining an ETT airway cuff pressure to 10 to 20 cm H2O.
D) Minimizing transport out of the ICU
E) Application of 5 to 8 cm H2O of PEEP
Answer: C
All of the above have shown to decrease the rate of VAP, but cuff pressure of ETT should be maintained at 20 to 30 cm H2O.
In above question choice D is an interesting choice, but rationale behind relationship of VAP and Minimizing transport out of the ICU is the observational studies showing bedside resuscitation bags as a source of bacterial contamination.
References:
1. Kollef MH, Von Harz B, Prentice D, et al. Patient transport from intensive care increases the risk of developing ventilator-associated pneumonia. Chest 1997; 112:765.
2. Thompson AC, Wilder BJ, Powner DJ. Bedside resuscitation bags: a source of bacterial contamination. Infect Control 1985; 6:231.
3. Weber DJ, Wilson MB, Rutala WA, Thomann CA. Manual ventilation bags as a source for bacterial colonization of intubated patients. Am Rev Respir Dis 1990; 142:892.
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