A 65-year-old male is intubated and placed on a mechanical ventilator after a motor vehicle ac-cident

Thirty-six hours later he develops infiltrates on the chest radiograph. Which of the following ac-tions may have been able to prevent this from occurring?
1. Elevation of the head of the bed 20 to 30 degrees
2. Aspiration of subglottic secretions
3. Changing ventilator circuit every 24 hours
4. Stress ulcer prophylaxis
5. Avoid the use of sedatives
a. 1 only c. 1, 2, 4, and 5
b. 1, 3, and 5 d. 1, 2, 3, 4, and 5

ANS: C
The information indicates that the patient has ventilator-associated pneumonia; ventila-tor-associated pneumonia must be suspected anytime intubation develops shortly after endotra-cheal intubation. There are many actions that can be taken to prevent its development. Current standards state that the ventilator circuit should be changed only when it is grossly contaminated.