A patient receiving mechanical ventilation for 2 days demonstrates the following clinical features: • ? Purulent respiratory secretions • ? Body temperature 35.5 C • ? Leukopenia • ? Pao2 65 mm Hg What should the therapist suggest at this time?
A. blood culture
B. culture and sensitivity
C. bronchoscopy
D. chest radiograph
?ANS: D
A. Incorrect response: See explanation D.
B. Incorrect response: See explanation D.
C. Incorrect response: See explanation D.
D. Correct response: VAP should be suspected if two or more of the following clinical features are present:
• ? Purulent respiratory secretions
• ? Body temperature 35.5 C (>38 C and <36 C)
• ? Leukopenia
• ? Pao2 65 mm Hg (hypoxemia)
Once VAP is suspected, radiologic studies need to be done. If a newer or persistent chest radiographic abnormality is found, bacteriologic studies need to be performed, and empiric therapy should be started. The presence of a cavity by radiography or positive blood culture with the same pathogen isolated from the respiratory secretions confirms the diagnosis.?
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