The therapist is providing mechanical ventilation to a patient ...

[rosent76]

The therapist is providing mechanical ventilation to a patient who suffered TBI. The therapist is contemplating performing a recruitment maneuver on this patient. What should the therapist do?
 
  A. The therapist should not perform a recruitment maneuver.
  B. The therapist should conduct a modified recruitment maneuver.
  C. A recruitment maneuver would likely be beneficial for this patient.
  D. Because of the nature of this patient's lung status, a recruitment maneuver will not improve oxygenation.

Question 2

Based on citations in the text, which of the following statements are two concerning PEEP and patients with TBI? I. PEEP must be avoided unless absolutely necessary to avoid increases in ICP. II. Studies have revealed that PEEP does not increase ICP in patients with preexisting elevated ICPs. III. Other studies indicate that increasing levels of PEEP have no effect on ICP or CPP. IV. High PEEP levels may lead to slight rises in ICP in patients who have normal ICPs.
 
  A. I only
  B. III only
  C. II, IV only
  D. II, III, IV only

[lolol]

Answer to Question 1

ANS: A
A. Correct response: The use of recruitment maneuvers is controversial in patients with TBI. Most research data on this type patient have shown that recruitment maneuvers decrease MAP and increase ICP. Consequently the recommendation is to avoid the use of recruitment maneuvers in these type patients. Other protective lung strategies such as low Vts and the application of PEEP are advocated.
B. Incorrect response: See explanation A.
C. Incorrect response: See explanation A.
D. Incorrect response: See explanation A.

Answer to Question 2

ANS: D
A. Incorrect response: See explanation D.
B. Incorrect response: See explanation D.
C. Incorrect response: See explanation D.
D. Correct response: Traditional teaching has been that high levels of PEEP may lead to elevated ICP, and should be avoided in patients with TBI. While high PEEP levels may lead to slight increases in ICP in patients with normal ICPs, studies suggest that PEEP does not increase ICP in those patients with preexisting elevated ICPs. Data from a retrospective review show that rising levels of PEEP have no effect on ICP or CPP. Such data advocate the use of PEEP with appropriate monitoring in the head-injured population because the risks of hypoxia outweigh the potential risk of decreased CPP from reduced cardiac output or decreased venous return.