Author Question: The statement that is true concerning the use of permissive hypercapnia in the management of ... (Read 14 times)

gbarreiro · **on:** Jul 16, 2018

The statement that is true concerning the use of permissive hypercapnia in the management of patients with acute respiratory distress syndrome (ARDS) includes which of the following?

a. The pH may be allowed to drop as low as 7.1.
b. Tromethamine (THAM) may be used to keep the pH above 7.2.
c. Partial pressure of carbon dioxide (PaCO2) needs to rise rapidly to achieve success.
d. PaCO2 should not be allowed to rise above 60 mm Hg.

Question 2

An 18-year-old, 5'6, 125 lb female patient was admitted to the hospital 2 days ago for spinal meningitis.

She developed sepsis and suffered hypercapnic respiratory failure. The patient was intubated and placed on volume-controlled continuous mandatory ventilation (VC-CMV), respiratory frequen-cy (f) 12 breaths/min, tidal volume (VT) 600 mL, positive end-expiratory pressure (PEEP) 5 cm H2O, fractional inspired oxygen (FIO2) 0.40. Twenty-four hours later, the patient's oxygen re-quirements have dramatically increased and her lung compliance has dramatically dropped, while her chest X-ray showed development of bilateral fluffy infiltrates. The most appropriate actions to take include which of the following?
a. Keep VT the same, increase f to 25 breaths/min, increase PEEP to 12 cm H2O.
b. Decrease VT to 250 mL, increase f to 15 breaths/min, increase PEEP to 15 cm H2O.
c. Increase VT to 550 mL, decrease f to 8 breaths/min, increase PEEP to 10 cm H2O.
d. Decrease VT to 400 mL, decrease f to 8 breaths/min, decrease PEEP to 3 cm H2O.

connor417 · **Reply #1 on:** Jul 16, 2018

Answer to Question 1

ANS: B
Acceptable end points for the management of acute respiratory distress syndrome (ARDS) based on arterial blood gases (ABGs) are partial pressure of carbon dioxide (PaCO2) = 40-80 mm Hg; pH = 7.20-7.40; PaO2 = 60-100 mm Hg. Note that these values may vary among institutions. Some physicians prefer to use tromethamine (THAM) or sodium bicarbonate when pH drops be-low 7.20.

Answer to Question 2

ANS: B
During the acute phase of the disease, adequate ventilation should be provided using a tidal volume (VT) in the range of 4-6 mL/kg while plateau pressure (Pplateau) is maintained at <30 cm h2o with rates of 15-25 breaths>