The therapist is managing a patient who has been reestablished on ...

[jrubin]

The therapist is managing a patient who has been reestablished on mechanical ventilation after failing SBTs. How should the therapist manage the aspect of respiratory muscle loading for this patient?
 
  A. Provide the patient with a comfortable level of assisted ventilation.
  B. Sedate the patient and provide controlled mechanical ventilation.
  C. Gradually decrease the level of ventilator support before the next SBT.
  D. Progressively increase the level of ventilatory support before the next SBT.

Question 2

How should the therapist manage a patient who has failed a couple spontaneous breathing trials? I. Focus on preventing VILI. II. Reestablish a nonfatiguing mode of ventilatory support. III. Ascertain the cause of weaning failure. IV. Employ volume-controlled mechanical ventilation and sedation.
 
  A. I, III only
  B. I, IV only
  C. I, II, III only
  D. I, III, IV only

[daiying98]

Answer to Question 1

ANS: A
A. Correct response: An important consideration regarding a patient recommitted to ventilatory support is whether the level of support should be decreased over time. Doing so has been the traditional approach in terms of ventilator weaning. This approach has been based on the notion that progressive loading of the respiratory muscles would hasten the transition to unassisted spontaneous breathing. However, no data support the notion that loading recovering respiratory muscles above that required for breath triggering and comfort provides a physiologic benefit. The recommendation is to set a comfortable level of ventilatory support, and then adjust it if the patient's condition worsens.
B. Incorrect response: See explanation A.
C. Incorrect response: See explanation A.
D. Incorrect response: See explanation A

Answer to Question 2

ANS: C
A. Incorrect response: See explanation C.
B. Incorrect response: See explanation C.
C. Correct response: First, the focus must be on the cause of ventilator dependence. Efforts toward improving the respiratory drive, cardiac function, gas exchange, or muscle fatigue must be exercised. The plan must also focus on managing the ventilator and the patient's respiratory muscle loading. The therapist must work toward preventing VILI and providing a mode of mechanical ventilation that offers nonfatiguing synchronous respiratory muscle loading.
D. Incorrect response: See explanation C