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Ventilator-associated pneumonia — FRCA Final MCQ

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ModerateICUVentilator-associated pneumoniaFRCA Final

A 64-year-old woman on ICU after subarachnoid haemorrhage becomes febrile with new purulent secretions. She has been ventilated for six days, FiO2 requirement has increased from 0.35 to 0.60, and chest radiograph shows a new right lower zone infiltrate. What is the most appropriate management?

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Correct answer: D — Obtain respiratory cultures and start empiric antibiotics guided by local policy

The combination of prolonged ventilation, increased oxygen requirement, fever, purulent secretions and new infiltrate is consistent with ventilator-associated pneumonia. Cultures should be obtained where feasible before empiric antibiotics, guided by local resistance patterns and clinical severity. Extubation purely to prevent infection is unsafe if oxygenation has worsened. Procalcitonin may assist review but should not delay treatment in a deteriorating patient.

Reference: NICE antimicrobial prescribing guidance; Faculty of Intensive Care Medicine standards