What effect does positive-pressure ventilation have on fluid ...

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What effect does positive-pressure ventilation have on fluid balance?
 
  a. It increases urinary output.
  b. It increases renal perfusion.
  c. It causes renal malfunction.
  d. It increases plasma ADH levels.

Question 2

An invasively ventilated patient with ARDS is on PC-CMV, PIP = 30 cm H2O, PEEP = 12 cm H2O, FIO2 = 1.0. The patient's returned VT is 320 mL.
 
  The ABG results on these settings are: pH 7.3, PaCO2 53 mm Hg, PaO2 62 mm Hg. The patient is placed in the prone position, and after 1 hour, ABG results show: pH 7.38, PaCO2 46 mm Hg, PaO2 83 mm Hg. The respiratory therapist should do which of the following?
  a. Keep the patient in the prone position.
  b. Place the patient in the supine position.
  c. Keep the patient in the prone position and decrease the FIO2.
  d. Place the patient in the supine position and decrease PEEP.

[bubulittle310@msn.cn]

Answer to Question 1

ANS: D
Positive-pressure ventilation increases the plasma antidiuretic hormone level. Renal malfunction does directly affect fluid balance, but it is not caused by PPV. PPV decreases urinary output be-cause of the increased levels of ADH. PPV may also decrease renal perfusion.

Answer to Question 2

ANS: C
This patient has shown a positive response to the prone position; therefore, the patient can be maintained in this position for 2-12 hours. A reduction in the FIO2 would be appropriate, because the level is at 1.0.

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