Ventilator Associated Lung Injury
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Questions and Answers

Which of the following is a potential risk of using high PEEP during continuous positive airway pressure (CPAP) mode?

  • Decreased functional residual capacity of the lungs
  • Decreased minute volume
  • Increased respiratory muscle fatigue
  • Left ventricular dysfunction upon extubation (correct)

    • What is the normal PaO2/FiO2 ratio?

  • 75
  • 476 (correct)
  • 100
  • 150

    • Which of the following techniques provides continuous pressure support and may increase the functional residual capacity of the lungs?

  • Pressure Support Ventilation
  • T-Tube Trial
  • Continuous Positive Airway Pressure (CPAP) Mode (correct)
  • Automatic Tube Compensation

    • What is the goal respiratory rate during spontaneous breathing trials (SBT)?

    <p>Less than 35 breaths per minute</p> Signup and view all the answers

    What are the readiness criteria for weaning from ventilator support?

    <p>SaO2 &gt;90% on FiO2: 40% or less, PEEP 5 cm</p> Signup and view all the answers

    Which of the following is a sign of early failure during spontaneous breathing trials (SBT)?

    <p>Low tidal volume</p> Signup and view all the answers

    What is the PaO2/FiO2 ratio in the example of poor ratio provided in the text?

    <p>150</p> Signup and view all the answers

    Which mode of ventilation is also referred to as CMV?

    <p>Assist-control (A/C)</p> Signup and view all the answers

    When is the Assist-control (A/C) mode commonly used?

    <p>When patient is first intubated</p> Signup and view all the answers

    What is the potential complication of using Assist-control (A/C) mode?

    <p>Air trapping</p> Signup and view all the answers

    What is the total minute volume if a patient on Assist-control (A/C) mode does not breathe and has a tidal volume of 500ml and a respiratory rate of 12 breaths per minute?

    <p>6000ml/min</p> Signup and view all the answers

    What is the total minute volume if a patient on Assist-control (A/C) mode breathes at a rate of 30 breaths per minute with a tidal volume of 500ml?

    <p>15,000ml/min</p> Signup and view all the answers

    What is the main difference between Assist-control (A/C) mode and Synchronized Intermittent Mandatory Ventilation (SIMV) mode?

    <p>Patient's spontaneous effort determines tidal volume in A/C mode</p> Signup and view all the answers

    What is a potential advantage of using Synchronized Intermittent Mandatory Ventilation (SIMV) mode?

    <p>Patient has more control over their breathing</p> Signup and view all the answers

    Which mode is used to control plateau pressures in patients at risk for barotrauma, such as with ARDS or Pulmonary Fibrosis?

    <p>Pressure-Controlled Ventilation Mode (PCV)</p> Signup and view all the answers

    Which mode is used in conjunction with SIMV mode, but applies a pressure goal instead of volume?

    <p>Pressure-Support Ventilation Mode (PSV)</p> Signup and view all the answers

    Which mode is used to assist spontaneous breaths with pressure to overcome resistance to the endotracheal tube during weaning trials?

    <p>Pressure-Support Ventilation Mode (PSV)</p> Signup and view all the answers

    Which mode is used when ARDS is untreatable with more conventional modes?

    <p>Airway Pressure release Ventilation Mode (APRV)</p> Signup and view all the answers

    Which mode is used with airtight mask to administer two different pressure support levels, one for inspiration and one for expiration?

    <p>Bilevel Positive-Pressure Ventilation Mode (BiPAP)</p> Signup and view all the answers

    Which mode is used to assist spontaneous breathing by increasing end-expiratory pressure to improve oxygenation?

    <p>Continuous Positive Airway Pressure (CPAP)</p> Signup and view all the answers

    Which mode is a noninvasive method to administer positive-pressure ventilation, often used with obstructive sleep apnea (OSA)?

    <p>Continuous Positive Airway Pressure (CPAP)</p> Signup and view all the answers

    During extubation, what should be done after deflating the cuff?

    <p>Administer oxygen through a nasal cannula</p> Signup and view all the answers

    What is the recommended duration of voice rest after extubation?

    <p>4 to 8 hours</p> Signup and view all the answers

    What is the treatment for post-extubation stridor?

    <p>Both steroids IV and nebulized epinephrine</p> Signup and view all the answers

    What is the appropriate action to take when a patient self-extubates?

    <p>All of the above</p> Signup and view all the answers

    What are the barriers to ventilator weaning in the elderly?

    <p>All of the above</p> Signup and view all the answers

    What is the mortality rate of Acute Respiratory Distress Syndrome (ARDS)?

    <p>40% or higher</p> Signup and view all the answers

    Which of the following is NOT a criterion for the diagnosis of ARDS?

    <p>PaO2 of less than 50 mmHg</p> Signup and view all the answers

    What is the greatest risk factor for the development of ARDS?

    <p>Sepsis</p> Signup and view all the answers

    What is the characteristic feature of ARDS on chest x-ray?

    <p>Diffuse pulmonary infiltrates</p> Signup and view all the answers

    Which stage of ARDS is characterized by diffuse alveolar damage and increased interstitial and alveolar edema?

    <p>Stage 1 - Early Exudative Stage</p> Signup and view all the answers

    What is the main cellular change that occurs during Stage 2 of ARDS?

    <p>Collagen and myofibroblasts deposition</p> Signup and view all the answers

    Which of the following is a characteristic of Stage 3 of ARDS?

    <p>Increased ventilation management difficulties</p> Signup and view all the answers

    What is the term used to describe perfusion without ventilation in the lungs?

    <p>Shunt</p> Signup and view all the answers

    What is the PaO2:FiO2 ratio associated with more than 20% intrapulmonary shunt in ARDS?

    <p>100</p> Signup and view all the answers

    Which of the following is a sign of early failure during spontaneous breathing trials (SBT)?

    <p>Restlessness and agitation</p> Signup and view all the answers

    What is the goal of the renal system when there is a problem with the respiratory system?

    <p>To decrease HCO3</p> Signup and view all the answers

    What is a disease process that manifests as 'Dead Space' in the lungs?

    <p>Pulmonary embolism</p> Signup and view all the answers

    What is a potential complication of ARDS?

    <p>VAP</p> Signup and view all the answers

    What is the purpose of PEEP in mechanical ventilation?

    <p>To increase oxygenation</p> Signup and view all the answers

    What is the recommended range for PaO2 in a patient with ARDS?

    <p>80-100 mm Hg</p> Signup and view all the answers

    What are the sources of acids in the body?

    <p>Glucose metabolism</p> Signup and view all the answers

    What is the main difference between metabolic acidosis and respiratory acidosis?

    <p>Metabolic acidosis is characterized by a decrease in bicarbonate levels, while respiratory acidosis is characterized by an increase in CO2 levels.</p> Signup and view all the answers

    Which mode of ventilation allows the patient to breathe above the preset rate, with the tidal volume dependent on the patient's spontaneous effort?

    <p>Synchronized Intermittent Mandatory Ventilation (SIMV) mode</p> Signup and view all the answers

    What is the purpose of adding pressure support during spontaneous breaths in SIMV mode?

    <p>To minimize the risk of increased work</p> Signup and view all the answers

    In SIMV mode, if a patient takes a breath above the preset tidal volume, what happens?

    <p>The breath is not pushed to the full preset tidal volume</p> Signup and view all the answers

    Which mode of ventilation allows the patient to breathe above the preset rate, with the tidal volume dependent on the patient's spontaneous effort?

    <p>Synchronized Intermittent Mandatory Ventilation (SIMV) mode</p> Signup and view all the answers

    What is the purpose of PEEP in mechanical ventilation?

    <p>To prevent lung collapse</p> Signup and view all the answers

    What is the recommended range for PaO2 in a patient with ARDS?

    <p>Less than 60 mmHg</p> Signup and view all the answers

    Which mode of ventilation is used in patients with worsening hypoventilation and hypercapnia to prevent intubation?

    <p>Bilevel positive-pressure ventilation (BiPAP) mode</p> Signup and view all the answers

    What is the pressure support level provided during the inspiratory phase in Bilevel positive-pressure ventilation (BiPAP) mode?

    <p>12 cmH20</p> Signup and view all the answers

    What is the pressure support level provided during the expiratory phase in Bilevel positive-pressure ventilation (BiPAP) mode?

    <p>5 cmH20</p> Signup and view all the answers

    Which mode of ventilation is used to assist spontaneous breaths with pressure to overcome resistance to the endotracheal tube during weaning trials?

    <p>SIMV</p> Signup and view all the answers

    What is the purpose of adding pressure support during spontaneous breaths in SIMV mode?

    <p>To assist spontaneous breathing and improve oxygenation</p> Signup and view all the answers

    Which mode of ventilation is used to control plateau pressures in patients at risk for barotrauma, such as with ARDS or Pulmonary Fibrosis?

    <p>PSV</p> Signup and view all the answers

    Which mode is used to control plateau pressures in patients at risk for barotrauma, such as with ARDS or Pulmonary Fibrosis?

    <p>Pressure Support Ventilation</p> Signup and view all the answers

    What is the PaO2:FiO2 ratio associated with more than 20% intrapulmonary shunt in ARDS?

    <p>75/.5 = 150</p> Signup and view all the answers

    What is the mortality rate of Acute Respiratory Distress Syndrome (ARDS)?

    <p>70-80%</p> Signup and view all the answers

    Which mode of ventilation is used to assist spontaneous breaths with pressure to overcome resistance to the endotracheal tube during weaning trials?

    <p>Pressure support ventilation (PSV) mode</p> Signup and view all the answers

    What is the recommended duration of voice rest after extubation?

    <p>4 to 8 hours</p> Signup and view all the answers

    What is the recommended range for PaO2 in a patient with ARDS?

    <p>80-100 mmHg</p> Signup and view all the answers

    What are the readiness criteria for weaning from ventilator support?

    <p>Mental status alert and cooperative, good cough and gag reflex, able to protect airway and clear secretions</p> Signup and view all the answers

    Which of the following is a common bronchodilator used to open airways in patients with respiratory distress?

    <p>Albuterol</p> Signup and view all the answers

    What is the purpose of sedatives in the treatment of respiratory distress?

    <p>To decrease work of breathing</p> Signup and view all the answers

    What is the recommended positioning strategy for patients with respiratory distress?

    <p>Place the least affected area of lung in a dependent position</p> Signup and view all the answers

    Which positioning strategy is recommended for patients with respiratory distress?

    <p>Prone position</p> Signup and view all the answers

    What is the purpose of using vasopressors in ARDS therapy?

    <p>To maintain hemodynamic stability</p> Signup and view all the answers

    What is the purpose of using steroids in ARDS therapy?

    <p>To reduce inflammation</p> Signup and view all the answers

    Which of the following is a recommended therapy for ARDS?

    <p>Proning</p> Signup and view all the answers

    Which of the following is a protective lung strategy for ARDS?

    <p>Decreasing the inspiratory to expiratory ratio</p> Signup and view all the answers

    Which medication is used to reduce inflammation in ARDS therapy?

    <p>Steroids</p> Signup and view all the answers

    Study Notes

    Ventilation and Respiratory Support

    • High PEEP during CPAP can risk potential barotrauma and decreased cardiac output.
    • Normal PaO2/FiO2 ratio is approximately 300 mmHg.
    • Continuous positive airway pressure methods increase functional residual capacity of the lungs.
    • Goal respiratory rate during spontaneous breathing trials (SBT) is around 12-30 breaths per minute.
    • Readiness criteria for weaning from ventilator support include stable hemodynamics and minimal ventilatory settings.
    • Early signs of failure during SBT can include increased heart rate and decreased oxygen saturation.
    • A poor PaO2/FiO2 ratio example shows values less than 200 mmHg.
    • Controlled Mandatory Ventilation (CMV) is also known as Assist-Control (A/C) mode.
    • A/C mode is applied commonly for patients with poor respiratory drive or when sedation is used.
    • Potential complications of A/C mode include respiratory alkalosis due to overventilation.
    • Total minute volume in A/C mode without patient breaths at 500 mL tidal volume and a rate of 12 is 6000 mL.
    • In A/C mode at 30 breaths per minute and 500 mL tidal volume, the total minute volume is 15000 mL.
    • A/C mode provides mandatory breaths, while Synchronized Intermittent Mandatory Ventilation (SIMV) allows for spontaneous breaths in between.
    • An advantage of SIMV mode is that it may improve patient-ventilator synchrony.
    • Mode used to control plateau pressures in ARDS or Pulmonary Fibrosis is Pressure-Controlled Ventilation.
    • Pressure-Supported Ventilation is often used alongside SIMV to apply pressure support for spontaneous breaths.
    • Assist-control mode is beneficial for spontaneous breaths during weaning trials by providing pressure to offset tube resistance.
    • When ARDS is severe and unresponsive to standard therapies, High-Flow Nasal Cannula or ECMO may be employed.
    • Bi-level positive airway pressure (BiPAP) uses two pressure levels, higher for inspiration and lower for expiration.
    • Continuous Positive Airway Pressure (CPAP) assists spontaneous breathing by increasing end-expiratory lung volume.
    • Noninvasive Positive Pressure Ventilation (NIPPV) is effective for patients with obstructive sleep apnea.

    Post-Extubation Management

    • After cuff deflation during extubation, ensure the patient’s airway is clear and assess the need for supplemental oxygen.
    • Recommended duration of voice rest after extubation is 24-48 hours.
    • Treatment for post-extubation stridor often includes corticosteroids and nebulized epinephrine.
    • If a patient self-extubates, reassess breathing stability and readiness for reintubation if necessary.

    Acute Respiratory Distress Syndrome (ARDS)

    • Mortality rate of ARDS is approximately 30-40%.
    • Notable diagnostic criteria for ARDS includes acute onset within 1 week of a known insult.
    • Greatest risk factor for ARDS development is sepsis and pneumonia.
    • Chest X-ray of ARDS typically shows bilateral infiltrates.
    • Stage 1 of ARDS features minimal alveolar damage, while Stage 2 shows diffuse alveolar damage with increased edema.
    • Main cellular change in Stage 2 is the presence of alveolar macrophages and neutrophils.
    • Characteristic of Stage 3 includes severe hypoxemia and visual consolidation on imaging.
    • The term "shunt" describes perfusion without ventilation in the lungs.
    • A PaO2:FiO2 ratio indicative of more than 20% intrapulmonary shunt in ARDS is ≤200 mmHg.

    Acid-Base Balance and Ventilation

    • In the case of respiratory problems, the renal system aims to manage acid-base balance by retaining bicarbonate.
    • Conditions that manifest as 'Dead Space' in the lungs include Pulmonary Embolism.
    • Possible complications of ARDS include pulmonary fibrosis and chronic respiratory impairment.
    • Purpose of Positive End-Expiratory Pressure (PEEP) in mechanical ventilation is to maintain alveolar recruitment and improve oxygenation.
    • Recommended PaO2 range for ARDS patients is 55-80 mmHg.
    • Sources of acids in the body include metabolic processes and carbon dioxide from respiration.
    • Difference between metabolic acidosis and respiratory acidosis: metabolic acidosis results from increased acid production or decreased bicarbonate, while respiratory acidosis stems from inadequate ventilation.
    • Assist-Control (A/C) mode allows the patient to breathe above the preset rate, adjusting tidal volume based on effort.

    Strategies and Therapies for ARDS

    • Purpose of adding pressure support during spontaneous breaths in SIMV mode is to reduce the work of breathing.
    • In SIMV, if a patient exceeds the preset tidal volume, the machine allows for spontaneous larger breaths without penalization.
    • Special ventilation strategies such as protective lung strategies advocate low tidal volume settings for ARDS management.
    • Recommended therapies for ARDS may include lung-protective ventilation, prone positioning, and corticosteroids.
    • Vasopressors in ARDS therapy support hemodynamic stability in hypotensive patients.
    • Steroids are used in ARDS management to reduce inflammation.
    • Common bronchodilators for respiratory distress may include albuterol.
    • Sedatives help to manage anxiety and reduce respiratory distress during mechanical ventilation.
    • Recommended positioning for respiratory distress includes sitting up or in a semi-Fowler’s position for enhanced lung expansion.

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    Test your knowledge on the disease process that causes "Dead Space" in the lungs and learn about Ventilator Associated Lung Injury (VALI). Explore ventilation strategies such as permissive hypercapnia.

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