71 Questions
Which of the following is a potential risk of using high PEEP during continuous positive airway pressure (CPAP) mode?
Left ventricular dysfunction upon extubation
What is the normal PaO2/FiO2 ratio?
476
Which of the following techniques provides continuous pressure support and may increase the functional residual capacity of the lungs?
Continuous Positive Airway Pressure (CPAP) Mode
What is the goal respiratory rate during spontaneous breathing trials (SBT)?
Less than 35 breaths per minute
What are the readiness criteria for weaning from ventilator support?
SaO2 >90% on FiO2: 40% or less, PEEP 5 cm
Which of the following is a sign of early failure during spontaneous breathing trials (SBT)?
Low tidal volume
What is the PaO2/FiO2 ratio in the example of poor ratio provided in the text?
150
Which mode of ventilation is also referred to as CMV?
Assist-control (A/C)
When is the Assist-control (A/C) mode commonly used?
When patient is first intubated
What is the potential complication of using Assist-control (A/C) mode?
Air trapping
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?
6000ml/min
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?
15,000ml/min
What is the main difference between Assist-control (A/C) mode and Synchronized Intermittent Mandatory Ventilation (SIMV) mode?
Patient's spontaneous effort determines tidal volume in A/C mode
What is a potential advantage of using Synchronized Intermittent Mandatory Ventilation (SIMV) mode?
Patient has more control over their breathing
Which mode is used to control plateau pressures in patients at risk for barotrauma, such as with ARDS or Pulmonary Fibrosis?
Pressure-Controlled Ventilation Mode (PCV)
Which mode is used in conjunction with SIMV mode, but applies a pressure goal instead of volume?
Pressure-Support Ventilation Mode (PSV)
Which mode is used to assist spontaneous breaths with pressure to overcome resistance to the endotracheal tube during weaning trials?
Pressure-Support Ventilation Mode (PSV)
Which mode is used when ARDS is untreatable with more conventional modes?
Airway Pressure release Ventilation Mode (APRV)
Which mode is used with airtight mask to administer two different pressure support levels, one for inspiration and one for expiration?
Bilevel Positive-Pressure Ventilation Mode (BiPAP)
Which mode is used to assist spontaneous breathing by increasing end-expiratory pressure to improve oxygenation?
Continuous Positive Airway Pressure (CPAP)
Which mode is a noninvasive method to administer positive-pressure ventilation, often used with obstructive sleep apnea (OSA)?
Continuous Positive Airway Pressure (CPAP)
During extubation, what should be done after deflating the cuff?
Administer oxygen through a nasal cannula
What is the recommended duration of voice rest after extubation?
4 to 8 hours
What is the treatment for post-extubation stridor?
Both steroids IV and nebulized epinephrine
What is the appropriate action to take when a patient self-extubates?
All of the above
What are the barriers to ventilator weaning in the elderly?
All of the above
What is the mortality rate of Acute Respiratory Distress Syndrome (ARDS)?
40% or higher
Which of the following is NOT a criterion for the diagnosis of ARDS?
PaO2 of less than 50 mmHg
What is the greatest risk factor for the development of ARDS?
Sepsis
What is the characteristic feature of ARDS on chest x-ray?
Diffuse pulmonary infiltrates
Which stage of ARDS is characterized by diffuse alveolar damage and increased interstitial and alveolar edema?
Stage 1 - Early Exudative Stage
What is the main cellular change that occurs during Stage 2 of ARDS?
Collagen and myofibroblasts deposition
Which of the following is a characteristic of Stage 3 of ARDS?
Increased ventilation management difficulties
What is the term used to describe perfusion without ventilation in the lungs?
Shunt
What is the PaO2:FiO2 ratio associated with more than 20% intrapulmonary shunt in ARDS?
100
Which of the following is a sign of early failure during spontaneous breathing trials (SBT)?
Restlessness and agitation
What is the goal of the renal system when there is a problem with the respiratory system?
To decrease HCO3
What is a disease process that manifests as 'Dead Space' in the lungs?
Pulmonary embolism
What is a potential complication of ARDS?
VAP
What is the purpose of PEEP in mechanical ventilation?
To increase oxygenation
What is the recommended range for PaO2 in a patient with ARDS?
80-100 mm Hg
What are the sources of acids in the body?
Glucose metabolism
What is the main difference between metabolic acidosis and respiratory acidosis?
Metabolic acidosis is characterized by a decrease in bicarbonate levels, while respiratory acidosis is characterized by an increase in CO2 levels.
Which mode of ventilation allows the patient to breathe above the preset rate, with the tidal volume dependent on the patient's spontaneous effort?
Synchronized Intermittent Mandatory Ventilation (SIMV) mode
What is the purpose of adding pressure support during spontaneous breaths in SIMV mode?
To minimize the risk of increased work
In SIMV mode, if a patient takes a breath above the preset tidal volume, what happens?
The breath is not pushed to the full preset tidal volume
Which mode of ventilation allows the patient to breathe above the preset rate, with the tidal volume dependent on the patient's spontaneous effort?
Synchronized Intermittent Mandatory Ventilation (SIMV) mode
What is the purpose of PEEP in mechanical ventilation?
To prevent lung collapse
What is the recommended range for PaO2 in a patient with ARDS?
Less than 60 mmHg
Which mode of ventilation is used in patients with worsening hypoventilation and hypercapnia to prevent intubation?
Bilevel positive-pressure ventilation (BiPAP) mode
What is the pressure support level provided during the inspiratory phase in Bilevel positive-pressure ventilation (BiPAP) mode?
12 cmH20
What is the pressure support level provided during the expiratory phase in Bilevel positive-pressure ventilation (BiPAP) mode?
5 cmH20
Which mode of ventilation is used to assist spontaneous breaths with pressure to overcome resistance to the endotracheal tube during weaning trials?
SIMV
What is the purpose of adding pressure support during spontaneous breaths in SIMV mode?
To assist spontaneous breathing and improve oxygenation
Which mode of ventilation is used to control plateau pressures in patients at risk for barotrauma, such as with ARDS or Pulmonary Fibrosis?
PSV
Which mode is used to control plateau pressures in patients at risk for barotrauma, such as with ARDS or Pulmonary Fibrosis?
Pressure Support Ventilation
What is the PaO2:FiO2 ratio associated with more than 20% intrapulmonary shunt in ARDS?
75/.5 = 150
What is the mortality rate of Acute Respiratory Distress Syndrome (ARDS)?
70-80%
Which mode of ventilation is used to assist spontaneous breaths with pressure to overcome resistance to the endotracheal tube during weaning trials?
Pressure support ventilation (PSV) mode
What is the recommended duration of voice rest after extubation?
4 to 8 hours
What is the recommended range for PaO2 in a patient with ARDS?
80-100 mmHg
What are the readiness criteria for weaning from ventilator support?
Mental status alert and cooperative, good cough and gag reflex, able to protect airway and clear secretions
Which of the following is a common bronchodilator used to open airways in patients with respiratory distress?
Albuterol
What is the purpose of sedatives in the treatment of respiratory distress?
To decrease work of breathing
What is the recommended positioning strategy for patients with respiratory distress?
Place the least affected area of lung in a dependent position
Which positioning strategy is recommended for patients with respiratory distress?
Prone position
What is the purpose of using vasopressors in ARDS therapy?
To maintain hemodynamic stability
What is the purpose of using steroids in ARDS therapy?
To reduce inflammation
Which of the following is a recommended therapy for ARDS?
Proning
Which of the following is a protective lung strategy for ARDS?
Decreasing the inspiratory to expiratory ratio
Which medication is used to reduce inflammation in ARDS therapy?
Steroids
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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