What is the most appropriate intervention when a patient receiving mechanical ventilation has thick, white secretions in the endotracheal tube?

When a patient receiving mechanical ventilation has thick, white secretions in the endotracheal tube, adding additional water to the patient's enteral feedings is the most appropriate intervention. This approach helps to maintain hydration and improve the consistency of secretions. Thick secretions can be indicative of dehydration or insufficient fluid intake, and enhancing hydration through enteral feedings can assist in thinning these secretions, making them easier to manage and clear as needed.

In contrast, repositioning the patient frequently may help improve mobilization of secretions but does not directly address the viscosity of the secretions. Increasing suctioning frequency could be considered, but it may lead to potential complications such as airway trauma or hypoxemia without addressing the underlying issue of dehydration. Instilling sterile saline into the ET before suctioning is a technique that some practitioners use; however, it is not universally recommended due to concerns that it can lead to complications such as contamination, worsening secretions, or pulmonary complications. Thus, increasing enteral hydration is a more effective and safer method to manage and potentially alleviate the problem of thick secretions.