How does the set inflation pressure (Phigh) with APRV compare ...

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How does the set inflation pressure (Phigh) with APRV compare with conventional ventilation?
 
  A. It is a gross underestimate of end-inspiratory transpulmonary pressure.
  B. Spontaneous breathing during the inflation phase lessens the end-inspiratory stretching pressure on the lung.
  C. The periodic rapid deflation-reinflation during the prolonged inflation phase diminishes the incidence of lung injury.
  D. It results in underinflation of healthy lung units and adequate inflation of low compliant lung regions.

Question 2

The therapist is using the PEEP-Fio2 table to establish a level of PEEP appropriate for a mechanically ventilated patient with ARDS. The patient currently has a Pao2 of 88 mm Hg while receiving a PEEP of 10 cm H2O on an Fio2 of 0.50. What adjustment does the therapist need to make at this time? Use the Low & High PEEP Approach tables if necessary.
 
  A. Because the patient's Pao2 is 88 mm Hg, use the high PEEP approach.
  B. Using the low PEEP approach, move along the table to the left.
  C. Using the low PEEP approach, move along the table to the right.
  D. Using the high PEEP approach table, move along the table to the left.

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Answer to Question 1

ANS: A
A. Correct response: Unlike conventional ventilation, the set inflation pressure with APRV is a gross underestimate of end-inspiratory transpulmonary pressure.
B. Incorrect response: Spontaneous breathing during the inflation period will add to the end-inspiratory stretching pressure on the lung.
C. Incorrect response: The prolonged high pressure inflations and periodic deflations-reinflations may potentially injure the lungs.
D. Incorrect response: This statement is false.

Answer to Question 2

ANS: B
A. Incorrect response: Clinical studies have shown that more modest PEEP approaches render equivalent outcomes compared with more aggressive PEEP approaches.
B. Correct response: The clinical target is a Pao2 of 55 to 80 mm Hg, or an Spo2 of 85 to 95. If the patient's Pao2 is below these target values, move along the table to the right. If the patient's Pao2 is above these target values, move along the table to the left. Therefore, in this question, since the patient has a Pao2 of 88 mm Hg, which is above the Pao2 target of 55 to 80 mm Hg, the therapist needs to move along the low PEEP table to the left.
C. Incorrect response: See explanation B.
D. Incorrect response: Clinical studies have shown that more modest PEEP approaches render equivalent outcomes compared with more aggressive PEEP approaches.

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TYSM

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Excellent