To reduce the risk of Ventilator-Associated Pneumonia (VAP) in a 3-year-old patient, which two methods should be recommended?

Maintaining the head of the bed elevated at an angle of 30-45 degrees is a widely accepted practice in reducing the risk of Ventilator-Associated Pneumonia (VAP). This position helps prevent the aspiration of secretions, as gravity aids in keeping potential pathogens from moving into the lungs. For pediatric patients, especially those on mechanical ventilation, this elevating technique is critical in enhancing respiratory function and minimizing the colonization of bacteria in the airways.

The use of closed suction catheters also plays an important role in reducing VAP. Closed suction systems allow for suctioning of secretions without disconnecting the ventilator circuit, which helps maintain positive pressure and reduce exposure to room air that could introduce pathogens. This method minimizes disruption to ventilation and reduces the risk of introducing bacteria into the patient's airways during the suctioning process.

While changing ventilator circuits periodically and utilizing small-volume nebulizers (SVNs) for delivering bronchodilators may be beneficial in certain contexts, they are not specifically targeted to reduce the risk of VAP as effectively as the combination of keeping the head elevated and using closed suction catheters. Hence, the selected methods directly address key strategies in infection control and preventative care in a ventilated pediatric patient.