A 3-year-old child receiving positive pressure ventilation shows coarse crackles in both upper lobes. What should the specialist recommend?

In this scenario, the presence of coarse crackles in both upper lobes of a 3-year-old child receiving positive pressure ventilation indicates the likelihood of retained secretions or mucus in the airways. The correct recommendation is to perform endotracheal suction.

Endotracheal suction is a procedure aimed at clearing secretions from the trachea and bronchi, which can significantly improve airway patency and oxygenation in patients who are mechanically ventilated. By removing these secretions, it can help alleviate the crackles noted during auscultation, indicating that the airways are becoming clearer and that ventilation may be more effective.

While bronchial hygiene can refer to various methods of maintaining clear airways and includes activities such as postural drainage or chest physiotherapy, in acute settings where crackles are present due to excessive secretions, direct suctioning of the airway is often the most immediate and effective intervention.

Aerosolized bronchodilators may help if there is bronchospasm, but in this case, the primary issue appears to be related to secretions rather than airway constriction. Diuretic therapy could be relevant for managing fluid overload but is not indicated for addressing the crackles caused by retained secretions.