Dear Editor,

I read Mr. Pruitt's article on mechanical ventilation1 with interest to see how much remained of my old ICU memories and what was new in evidence-based practice. Much of my airway management learning came from an excellent respiratory therapist. I noticed, however, a few items in the text that perhaps needed clarification:

* Pg 28. The patient is supplied "air." Perhaps to be more precise would be "air with additional amounts of oxygen." They do not just receive "air."

* Pg 32. Blue box with description versus order. The description has "8 b/min," while the order reads "f-14."

* Pg 34. No mention of how often to move the endotracheal tube-daily, every other day, hospital protocol?

* Pg 34. There is no mention of good oral care to help reduce VAP and promote patient comfort.

-Susan Wright, MPH, BSN, RN, RN-BC

Dear Susan Wright,

Thank you for your feedback.

On page 28, you noticed the wording, "The patient is supplied with air from the ventilator..." You are correct in that this is a little imprecise. Patients on ventilatory support receive air enriched with oxygen (generally ranging from a low of about 24% up to 100% FiO₂), while "room" air has an FiO₂ of about 21%. Please forgive this slip on my part.

On page 32, where I describe examples of ventilator orders, you noted that the long version of an order mentions a frequency of 8, while the abbreviated order states 14. You are correct (good catch on your part). This was missed in the review and revision. The correct abbreviated order should read "PC-IMV, PIP 25, f-8, FiO₂ .40, 5 cm H₂O PEEP, 10 cm H₂O PS."

On page 34, you noted the lack of a mention of how often to reposition an endotracheal tube (ETT). Please keep in mind that the focus of this article is the basics of mechanical ventilation. Generally, an ETT should be repositioned from one side of the mouth to the other every 8 to 12 hours or once per shift.2

Lastly, you also noted that I do not mention good oral care to help prevent or reduce ventilator-associated pneumonia (VAP) and to promote patient comfort. Oral care, such as brushing teeth, suctioning the mouth, and using chlorhexidine mouthwash or gel has been shown to reduce VAP. It should be included in the overall care of the patient receiving mechanical ventilation via an ETT.3

-Bill Pruitt, MBA, RRT, CPFT, AE-C, FAARC

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