A patient with ALI is being ventilated using APRV with the ...

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A patient with ALI is being ventilated using APRV with the following settings: Phigh = 30 cm H2O; Plow = 2 cm H2O; Thigh = 6 seconds; Tlow = 0.8 sec; FIO2 = 0.4. The patient's spontaneous rate is 12 breaths/min.
 
  The current ABG values are: PaO2 = 61 mm Hg; PaCO2 = 43 mm Hg. What change should the respiratory therapist recommend for this patient?
  a. Decrease the Phigh to 25 mm Hg.
  b. Increase the Thigh to 8 seconds.
  c. Decrease the Tlow to 0.5 second.
  d. Increase the Plow to 5 cm H2O.

Question 2

Weaning from APRV includes which of the following?
 
  a. Increasing the Phigh and decreasing the Thigh
  b. Decreasing the Phigh and increasing the Thigh
  c. Increasing the Plow and decreasing the Tlow
  d. Decreasing the Plow and increasing the Tlow

[sylvia]

Answer to Question 1

ANS: B
To improve oxygenation during the use of APRV, the Phigh establishes the mPaw, which maintains oxygenation by restoring the functional residual capacity. Decreasing the Phigh would derecruit some alveoli and may create a more difficult situation. Increasing the Thigh may be done in 0.5- to 2-second intervals until the oxygenation target is achieved. The Tlow aids the removal of CO2 and helps determine tidal volume.

Answer to Question 2

ANS: B
Weaning from APRV requires drop and stretch. This means decreasing the Phigh and increasing the time at that pressure level by 2-3 cm H2O.

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TYSM

Excellent