— 降低風險 · HARD · MCQ —
下列哪項護理介入對於預防呼吸器相關肺炎（VAP）最為有效？
Which of the following interventions by the nurse is most effective in preventing ventilator-associated pneumonia (VAP)?
- APerforming oral hygiene with chlorhexidine once a day每天使用氯己定進行口腔清潔
- BSuctioning the endotracheal tube every hour每小時抽吸氣管內管
- CMaintaining the head of the bed at an angle of 30 to 45 degrees✓ 正解保持床頭抬高 30 至 45 度角
- DChanging the ventilator circuit tubing every 24 hours每 24 小時更換呼吸器管路
— Explanation · 中文詳解 —
預防 VAP 的實證醫學指引中，抬高床頭 30-45 度能有效防止胃內容物逆流及誤吸。口腔護理建議每日多次而非僅一次。管路更換頻率不應過於頻繁，定時抽痰非 VAP 預防之核心指標，過度抽痰反而增加黏膜損傷。
Evidence-based guidelines for VAP prevention recommend elevating the head of bed 30-45 degrees to effectively prevent gastric reflux and aspiration. Oral care should be performed multiple times daily rather than only once. Tubing changes should not be performed too frequently, and scheduled suctioning is not a core component of VAP prevention; excessive suctioning instead increases mucosal injury.
✦ 台美臨床差異
台美 ICU 皆有 VAP bundle（組合式照護），但美國對護理師依據指標執行抽痰的自主性更高。