The low-pressure and low-tidal volume alarms are sounding on a ...

[savannahhooper]

The low-pressure and low-tidal volume alarms are sounding on a mechanically ventilated patient. Measurement of the cuff pressure reveals 18 cm H2O. What action should be taken?
 
  a. Replace the endotracheal tube with a larg-er size.
  b. Add enough air to the cuff to maintain the cuff pressure at 34 cm H2O.
  c. Increase the set pressure to increase the tidal volume and compensate for the leak.
  d. Add air until a slight leak is heard while auscultating the larynx, then measure pressure.

Question 2

A patient's transairway pressure (PTA) is rising while the plateau pressure (Pplateau) remains un-changed. The treatment plan that could correct this problem includes which of the following?
 
  1. Administer a bronchodilator.
  2. Insert a chest tube.
  3. Measure unintended positive end-expiratory pressure (auto-PEEP).
  4. Suction airway secretions.
  a. 2 only
  b. 2 and 4 only
  c. 1 and 4 only
  d. 1 and 3 only

[deja]

Answer to Question 1

ANS: D
The minimum leak technique (MLT) should be used whenever possible to avoid tracheal necrosis associated with cuff overinflation. The size of the tube and patient is not given, so one cannot say whether or not the endotracheal (ET) tube is too small. 34 cm H2O is the maximum pressure that should be in a cuff. However, since all airways are different, the most effective way to minimize the risk of tracheal problems is to use MLT.

Answer to Question 2

ANS: C
Airway resistance can be estimated for a ventilated patient using transairway pressure (PTA). When the PTA rises, the airway resistance is rising. When plateau pressure (Pplateau) is constant, this means that the static compliance has not changed. In this question the PTA is rising while the Pplat-eau remains the same. This is due to an increase in Raw and can be corrected by administering a bronchodilator and/or suctioning the airways. An increase in Pplateau could occur from a pneumo-thorax, which would require the insertion of a chest tube and also from dynamic hyperinflation, which can be measured as unintended positive end-expiratory pressure (auto-PEEP).

[savannahhooper]

TYSM

Gracias!