Author Question: What conclusion was drawn regarding the use of permissive hypercapnia as a lung protective strategy ... (Read 11 times)

Metfan725 · **on:** Jul 16, 2018

What conclusion was drawn regarding the use of permissive hypercapnia as a lung protective strategy for limiting VILI in patients with ALI?

A. The data were inconclusive.
B. Permissive hypercapnia worked best with patients who were ventilated with VTs around 6 ml/kg.
C. Permissive hypercapnia significantly reduced the mortality rate in patients ventilated with VTs of 12 ml/kg.
D. The data did not detect any difference between permissive hypercapnia, and ALI patients receiving conventional or high-VT ventilation in limiting VILI.

Question 2

Based on the phase III ARDSnet trial, which was randomized for low versus high levels of PEEP in ALI patients, what outcome was obtained?

A. Patients who were ventilated with high tidal volumes and low PEEP were at a higher risk for developing VILI.
B. Patients who were ventilated with low tidal volumes and low PEEP were at a higher risk for developing VILI.
C. Patients who were ventilated with low VTs and whose Pplateau were maintained at or below 30 cm H2O were at a lower risk for developing VILI.
D. No benefit was found for ALI patients receiving low tidal volumes and higher levels of PEEP.

Tabitha_2016 · **Reply #1 on:** Jul 16, 2018

Answer to Question 1

ANS: C
A. Incorrect response: See explanation C.
B. Incorrect response: See explanation C.
C. Correct response: Data suggest that hypercapnic acidosis may have a protective effect against VILI on ALI patients receiving conventional or high tidal volume ventilation. Permissive hypercapnia is an acceptable consequence of lung-protective ventilation. Experimental data have also provided evidence that hypercapnic acidosis has favorable anti-inflammatory properties.
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: The ARDSNetwork conducted a phase III randomized controlled trial of higher versus lower PEEP in ALI patients. In that study, 549 patients were randomly assigned to either higher or lower PEEP levels in combination with FIO2, according to a priori tables. All patients were ventilated with tidal volumes of 6 ml/kg predicted body weight and a goal of limiting plateau pressures to 30 cm H2O. Mean PEEP in the high PEEP group was 13.2 cm H2O, and 8.2 cm H2O in the low PEEP group. This study suggests that when ALI patients receive ventilation with low VT, no benefit from the use of higher levels of PEEP appears to occur.