A "ventilator bundle" may include which of the following?
1. Keeping the head of the bed at 30 degrees from the horizontal.
2. Changing the ventilator circuits every 48 hours.
3. Using heated humidifiers whenever possible.
4. Using noninvasive positive pressure ventilation (NPPV) whenever possible.
a. 1 and 3 only
b. 1 and 4 only
c. 2 and 3 only
d. 1, 2, and 4 only
ANS: B
"Ventilator bundles" are evidence-based practices that can significantly reduce the incidence of VAP. Keeping the patient in a semirecumbent position decreases the risk of aspiration. Using NPPV when possible can significantly lower the rate of nosocomial pneumonia. Ventilator cir-cuits should be changed only when they are visibly dirty, and HMEs should be used whenever possible, because most can filter and all can eliminate condensation in the ventilator circuit.
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