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Chapter 12
Management of Mechanical Ventilation
| Question | Answer |
|---|---|
| The primary strategy to improve ventilation include all of the following except: A. increase mechanical deadspace B. increase ventilator tidal volume C. increase ventilator frequency D. increase in pressure support for spontaneously breathing patient | A. increase mechanical deadspace |
| Dr McFarland ask the therapist to adjust the ventilator in order to improve the oxygenation status of the patient with normal V/Q status. Which of the following ventilator adjustments would have the most direct effect on oxygenation? | increase oxygenation concentration(FiO2) |
| In uncomplicated hypoxemia, the primary strategy to improve oxygenation is to________the FIO2, PEEP | increase |
| Permissive hypercapnia, intentional hypo-ventilation by reducing ventilator tidal volume to a range of 4-7mL/kg(normally 10mL/kg). It is done to lower pulmonary pressures | -to reduce the incidence of ventilator-related lung injuries -induced respiratory acidosis is managed by bicarbonate or tromethamin |
| A recent arterial blood gas report of a patient with chronic bronchitis shows mild hypoxemia. The initial method to improve the patient's oxygenation status is to: | increase the FIO2 |
| Oxygen therapy corrects uncomplicated hypoxemia because a higher FIO2 increases_____enhances the diffusion of_____from the lungs into the pulmonary circulation | -the alveolar-capillary oxygen pressure gradient across the A-C membrane -oxygen |
| Oxygen therapy is very effective in correcting hypoxemia due to : | simple V/Q mismatch |
| Refractory hypoxemia is usually caused by_____, and it ______respond very well to oxygen therapy alone. | -intrapulmonary shunting -does not |
| Refractory hypoxemia responds____to supplemental oxygen when used with CPAP and PEEP. | -well |
| CPAP and PEEP is useful in the treatment of refractory hypoxemia caused by | intrapulmonary shunting |
| Optimal PEEP can be titrated by using different indicators using pulse oximetry saturation (SpO2). Based on these data, the optimal PEEP is (0,4,7,10)cm H2O | 10cm H20 |
| Optimal PEEP is the lowest pressure level that offers the most benefits with the least side effects. Explain why. | to minimize cardiovascular complications |
| Permissive hypercapnia is a technique in which the mechanical________is reduced. This change is done intentionally to increase a patient's______volume range 4-7mL/kg (normally 10mL/kg) | -tidal volume -PaCO2 |
| During weaning of a patient who has been using 10 cm H2O of PEEP and 70% oxygen, the (PEEP,FIO2) should be reduced first until it reaches about (5cmH2O, 40%) | -FIO2 -40% |
| Three major causes of metabolic acidosis are_______,_______,and________in severe hypoxia | -renal failure -diabetic ketoacidosis -lactic acid |
| An increase in minute ventilation and a decrease in PaCO2 may be a response to metabolic acidosis(e.g.,________,_________and_________in severe hypoxia) | -renal failure -diabetic ketoacidosis -lactic acid |
| Ventilatory (respiratory) intervention (should,should not) be used to compensate or correct primary metabolic acid-base problems | -should not |
| The pressure alarms are triggered when the circuit pressure (exceeds, drops below) the preset low pressure limit. | -drops below |
| Factors that trigger the low pressure alarm usually (will, will not) trigger the low volume alarm | -will |
| Conditions that may trigger the low pressure alarm include all of the following except: loss of circuit or system pressure (common) premature termination of inspiratory phase obstruction of ventilator circuit inappropriate ventilator setttings | obstruction of ventilator circuit |
| The high pressure alarm is triggered when the circuit pressure reaches or exceeds the preset (high,low) pressure limit | -high |
| Conditions that may trigger the high pressure alarm include all of the following factors except: disconnection of ventilator circuit increase of airflow resistance decrease of lung compliance decrease of chest wall compliance | disconnection of ventilator circuit |
| What are some mechanical factors that may trigger the high pressure alarm due to an increase of airflow resistance | -kinking of circuit -kinking of ET tube -blocked exhalation manifold -water in circuit |
| What are three patient factors that may trigger the high pressure alarm due to an increase of airflow resistance | -bronchospasm -coughing -biting the ET tube |
| A patient's low pressure alarm is triggered persistently. The likely cause of this condition include all the following except: disconnection of ventilator circuit kinking of endotracheal tube power failure leakage of endotracheal tube cuff | kinking of endotracheal tube |
| During patient rounds in the ICU, the high pressure alarm of the ventilator is triggered. This condition is likely caused by: disconnection of ventilator of circuit low pressure limit set too high loose ventilator humidifier fitting patient coughing | patient coughing |
| The high respiratory frequency alarm is triggered when the total frequency exceeds the high frequency limit set on the ventilator except for: respiratory distress excessive sensitivity setting high frequency alarm set too low circuit disconnect | circuit disconnect (loss of circuit pressure in low pressure/low volume alarm) |
| All the following conditions may trigger the apnea/low respiratory frequency alarm except: oversedation circuit disconnection prolonged neuromuscular block respiratory muscle fatigue coughing | coughing |
| The high PEEP alarm is triggered when the actual PEEP level (exceeds,drops below) the preset PEEP limit | exceeds |
| Presence of excessive auto-PEEP may triggered the high PEEP alarm. All the following conditions may lead to the development of auto-PEEP except: air trapping inadequate inspiratory time insufficient inspiratory flow insufficient expiratory time | inadequate inspiratory time |
| Auto-PEEP may be reduced by (increasing,decreasing) the tidal volume or mandatory frequency, or (increasing, decreasing) the inspiratory flow rate on the ventilator | -decreasing -increasing |
| If a metered-dose inhaler is used in conjunction with an HME, the | MDI must be placed between the HME and patient |
| A heat and moisture exchanger (HME) may be used as a ________humidification device for intubated patients | temporary |
| The optimal interval for ventilator circuit change is all of the following except: changed when visibly soiled once per week everyday | everyday |
| Minute ventilation=(ventilator VT x ventilator f) + (spontaneous VT x spontaneous f)the minute ventilation can be increased by all the following strategies: increase the ventilator VT increase the ventilator f increase the spontaneous VT T/F | -True |
| Permissive hypercapnia is a strategy used to minimize the occurrence of ventilator related lung injuries caused by positive pressure ventilation. May be done by by selection a tidal volume within range of ___to ____mL/kg, Normally________ | -4 to 7 mL/kg -10 mL/kg |
| The (pH,PaCO2,PaO2) levels are allowed to increase beyond the normal limits of 10 mL/kg when permissive hypercapnia is used to reduced the patient's _____during mechanical ventilation tidal volume pH pulmonary pressures frequency | -PaCO2 pulmonary pressures |
| (CPAP,PEEP) is used for patients with adequate spontaneous ventilation for a sustainable normal PaCO2 and____(CPAP, PEEP) is used for patients requiring mechanical ventilation | -CPAP -PEEP |
| Oxygen therapy corrects uncomplicated hypoxemia because higher FIO2(increases,decreases ) the alveolar-capillary oxygen pressure gradient and enhances the diffusion of (oxygen, carbon dioxide) from the lungs into the pulmonary circulation | -increases -oxygen |
| Loss of circuit pressure may be caused from all the following: | -circuit disconnection -exhalation valve drive-line disconnection -endotracheal tube cuff leak -loose circuit connection -loose humidifier connection |
| An acute and severe reduction of lung or chest wall compliance may also trigger the high pressure alarm. list 4 conditions that may cause a reduction of the lung or chest wall compliance | -Tension pneumothorax -Atelectasis -ARDS -Pneumonia |
| Incidence of suction-induced (alkalosis, hypercapnia, hypoxia) may be reduced by using a(n) (open, closed inline) suctioning system and (hyperventilating, preoxygenating) the patient before suction. | -hypoxia -closed inline -preoxygenating -use lukens trap to collect sputum samples |
| ________________is more time-consuming, but it can identify the microbes and the most suitable antibiotics for the infection | culture and sensitivity |
| There are several potential sources of pathogens that can lead to pneumonia in the mechanically ventilated patient. match likely sources patient manual ventilation bag health care provider oropharynx equipment and supplies hands | patient, oropharynx health care provider, hands equipment and supplies, manual ventilation bag |
| Excessive nutrition or high caloric intake can cause respiratory distress due to(increased,decreased) oxygen consumption and (increased, decreased) carbon dioxide production | -increase -increase |
| Use of low tidal volume, prone positioning (PP), VT range from 5-9 mL/kg and trachea gas sufflation are ( routine, adjuntive) management strategies in mechanical ventilation. | Adjunctive |
| For patients with normal lung functions, traditional tidal volumes used during mechanical ventilation range from (5-9, 10-12, 15-18) mL/kg | 5-9mL/kg |
| List three complications of using low tidal volumes( e.g., 5-9 mL/kg) in mechanical ventilation | -acute hypercapnia -increase WOB -dyspnea -severe acidosis - actelectasis |
| Contraindications for PP include (increases, decreased) intracranial pressure, hemodynamics instability, unstable spinal injury, (absence of, history of)abdominal or thoracic surgery, flail chest, inability to tolerate PP | -increase -absence of |
| After one hour of PP, a(n) (increase, decrease) of OI by 20% or greater from baseline value suggest a beneficial respons. | Increase |
| For optimal beneficial effect, pediatric patients should remain in the PP for a period of at least (3,6,12) | 12hours |
| For adult patients, they should remain in the PP for a period of at least (3,6,12) hours s loreated | 6 hours |
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