Which of the following goals of mechanical ventilatory support of ...

[BRWH]

Which of the following goals of mechanical ventilatory support of parenchymal lung injury have resulted in significant improvement in outcomes? I. accepting lower Pao2 values II. allowing lower pH values III. employing aggressive PEEP-Vt combinations IV using lower tidal volumes
 
  A. I, II only
  B. II, IV only
  C. I, II, IV only
  D. I, III, IV only

Question 2

Which of the following statements are features of APRV? I. Cardiac output increases during the inflation phase. II. Spontaneous breathing is possible during the inflation phase. III. Alveolar recruitment occurs during the inflation phase. IV. The long inflation time often causes intrinsic PEEP.
 
  A. II, IV only
  B. I, II, III only
  C. I, III, IV only
  D. II, III, IV only

[Missbam101]

Answer to Question 1

ANS: C
A. Incorrect response: See explanation C.
B. Incorrect response: See explanation C.
C. Correct response: The goals of mechanical ventilatory support of parenchymal lung injury have shifted over the last decade to providing smaller tidal volumes, and accepting consequently lower arterial values for Po2 and the development of respiratory acidosis. These goals have resulted in significant improvements in outcomes.
D. Incorrect response: See explanation C

Answer to Question 2

ANS: D
A. Incorrect response: See explanation D.
B. Incorrect response: See explanation D.
C. Incorrect response: See explanation D.
D. Correct response: APRV is a pressure-targeted mode of ventilation. APRV allows for spontaneous breathing to occur during the inflation phase. This capability allows for the use of long inflation times to recruit alveoli while enabling patients to continue to breathe spontaneously. Taken together, the long inflation times (often resulting in intrinsic PEEP) can be considered an alternative way to raise mean pressures and maintain recruitment without applying additional PEEP or Vt.

[BRWH]

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