A 63-Year-Old Man with Chronic Obstructive Pulmonary Disease Comes to the Emergency

A 63-year-old man with chronic obstructive pulmonary disease comes to the emergency department due to 3 days of increasing dyspnea after running out of his maintenance and rescue inhalers.  At first, he had dyspnea with exertion only, but it is now present at rest and associated with wheezing and a nonproductive cough.  Chest x-ray reveals lung hyperinflation but no infiltrates.  The patient is admitted to the medical floor and started on appropriate therapy.  He does not respond to treatment; therefore, he is intubated and mechanically ventilated for worsening hypercapnia and increased work of breathing.  Following intubation, portable chest radiograph confirms appropriately positioned endotracheal tube with no infiltrates, effusions, or pneumothorax.  Which of the following interventions would be most likely to prevent this patient from developing ventilator-associated pneumonia?

A) Early parenteral nutrition via central line
B) Elevating the head of the bed to a 45-degree angle
C) Maintaining maximum sedation
D) Proton pump inhibitor for stress ulcer prophylaxis
E) Tight glycemic control with insulin infusion

Correct Answer:

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