Which of the following explains the basis for permissive ...

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Which of the following explains the basis for permissive hypercapnia as a ventilator strategy for ARDS?
 
  a. Introduction of CO2 into the breathing circuit to stimulate spontaneous breaths.
  b. Use of lower tidal volumes and accepting a gradual rise in PCO2 to avoid associated hazards of high Paw.
  c. Allow patients with ARDS to breathe spontaneously to build their respiratory muscular endurance.
  d. To use exhaled CO2 to increase residual volume and improve gas exchange.

Question 2

Which of the following statements is true about prone positioning of patients with ARDS?
 
  a. May be beneficial to patients with sus-tained severe ARDS (P/F ratio < 150 for more than 12 to 24 hr on stable ventilator settings).
  b. It dramatically reduces the mortality of patients with ARDS.
  c. It is easy to do and helps morbidity rates of patients with ARDS.
  d. It does not improve gas exchange at all.

[ebe]

Answer to Question 1

ANS: B
Thus, in managing patients with ARDS, the clinician must resist the urge to correct the PaCO2 value to normal. Instead, in the absence of a contraindication to hypercapnia (e.g., elevated intra-cranial pressure), we allow hypercapnia (permissive hypercapnia) with a goal to maintain the arterial pH at no less than 7.15 to 7.20. Even when PaCO2 rises to a point during which pH may become dangerously low (e.g., pH <7.15), the absolute need to keep the VT at 6 ml/kg IBW re-mains.

Answer to Question 2

ANS: A
However, as more centers gain comfort with the logistics of rotating patients, prone position ven-tilation has emerged as one of the first-line adjunctive therapies available to assist in oxygenating the severe ARDS patient, and is considered by many to now be the standard of care for patients with sustained severe ARDS (P/F ratio < 150 for more than 12 to 24 hr on stable ventilator set-tings).