An ICU quality improvement team reviews compliance with the ventilator care bundle aimed at preventing ventilator-associated pneumonia. Which element is a recognised component of this bundle?

• A Routine change of the ventilator circuit every 24 hours
• B Scheduled chest physiotherapy in all ventilated patients
• C Prophylactic nebulised aminoglycosides twice daily
• D Elevation of the head of the bed to 30 to 45 degrees ✓

Explanation

Head-of-bed elevation to 30 to 45 degrees reduces gastro-oesophageal reflux and aspiration of contaminated gastric and oropharyngeal secretions, and it is a core ventilator bundle element alongside sedation holds, peptic ulcer and DVT prophylaxis, oral care with chlorhexidine, and daily assessment of extubation readiness. Circuits are changed only when visibly soiled, not routinely every 24 hours, and neither prophylactic nebulised antibiotics nor universal chest physiotherapy forms part of the bundle.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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