Preservation of spontaneous breathing during mechanical ...

[ENagel]

Preservation of spontaneous breathing during mechanical ventilation favors the distribution of gas to which areas of the lung?
 
  a. Peribronchial area
  b. Upper airway
  c. Lung periphery
  d. Central airways

Question 2

The RT performs a patient-ventilator system check on a 24-year-old, 5-foot, 10-inch male patient who has been intubated because of a drug overdose.
 
  The RT notices what appears to be swelling around the patient's upper anterior chest and neck area. Palpation elicits a tissue paper feeling. The ventilator settings are: VC-CMV, rate 12/min with no patient assist, VT 900 mL, PEEP 5 cm H2O, FIO2 0.4, TI 1.2 sec. The most appropriate action for the RT to take is which of the following?
  a. Increase the set flow rate.
  b. Decrease the set tidal volume.
  c. Reduce the set respiratory rate.
  d. Perform emergency needle decompression.

[shailee]

Answer to Question 1

ANS: C
The distribution of gas during spontaneous ventilation favors the dependent lung areas and also appears to favor the periphery of the lung closest to the moving pleural surfaces. The peripheral areas receive more ventilation than the central areas. However, during a positive pressure breath with passive inflation of the lung (paralysis), the central, upper airway, or peribronchial portions of the lung are preferentially filled with air.

Answer to Question 2

ANS: B
Assessment of this patient reveals that he has subcutaneous emphysema, as evidenced by the swelling around the upper anterior chest and neck area and the tissue paper feeling on palpation. This is a form of barotrauma caused by alveolar rupture as a result of too much volume. The PEEP setting is only 5 cm H2O, which is physiologic. The VT setting, however, is too high. The IBW for this patient is 75 kg; 900  75 = a set volume of 12 mL/kg. This needs to be adjusted to 8-10 mL/kg. The subcutaneous emphysema should subside on its own.

[ENagel]

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