Preventing Complications of Pneumonia in the ICU

A 67-year-old woman was admitted to the ICU with multilobar pneumonia due to Streptococcus pneumoniae and COPD. She requires intubation and mechanical ventilation. All of the following are appropriate interventions to prevent complications in the ICU EXCEPT: 

A. Administration of enoxaparin 40 mg daily 

B. Administration of omeprazole 20 mg daily 

C. Aggressive blood glucose control 

D. Early mobilization and physical therapy while mechanically ventilated 

E. Use of a standard care bundle for insertion of central lines 


The answer is C. (Chap. 293) In patients admitted to the ICU, one of the most important aspects of care is to prevent complications that may occur during the process of care. One of the most common complications is nosocomial infections, including hospital- or ventilator-acquired pneumonia, catheter-related bloodstream infections, urinary tract infections, and Clostridium difficile infection. It is important to remove indwelling devices such as central lines, urinary catheters, and endotracheal tubes as soon as clinically possible. Another important preventative measure to decrease nosocomial infections includes ensuring appropriate sterile procedures for device insertion. Using care bundles and emphasizing good hand washing protocols are important strategies for decreasing nosocomial infections. Individuals in the ICU are also at increased risk of deep venous thrombosis due to immobility and often have factors that increase hypercoagulability. Standard interventions to prevent deep venous thrombosis include use of low-molecular-weight heparin or low-dose heparin along with sequential compression devices. Protection against development of stress ulcers is accomplished with histamine-2 blockers or proton pump inhibitors. The patients who benefit most from stress ulcer prophylaxis are those with coagulopathy, shock, or respiratory failure. Enteral nutrition is preferred over parenteral nutrition, although no definitive data demonstrate that early use of enteral nutrition provides benefit. ICU-acquired weakness is also a common complication of ICU care. The mechanisms are poorly understood. Interventions that may improve functional outcomes in critical illness include early physical and occupational therapy. Use of tight glucose control with intensive insulin therapy was thought to improve ICU outcomes, but further study has demonstrated no benefits on nosocomial infection and increased hypoglycemia with this mode of therapy. 



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