While the therapist mechanically ventilates a patient with ARDS, ...

[Marty]

While the therapist mechanically ventilates a patient with ARDS, the patient becomes grossly dyssynchronous with the ventilator. Why should the therapist make every effort to avoid using neuromuscular blocking agents?
 
  A. because neuromuscular blocking agents reduce O2 consumption
  B. because these medications adversely affect the ventilation time constant
  C. because the lung compliance increases leading to dynamic hyperinflation
  D. because of the risk of long-term myopathy

Question 2

While ventilating a grossly obese ARDS patient, the therapist notices that the Pplateau has suddenly risen from 30 cm H2O to 40 cm H2O. What should the therapist do at this time?
 
  A. Increase the pressure limit to enable a greater tidal volume delivery.
  B. Add PEEP to reduce the likelihood of dynamic hyperinflation.
  C. Measure the transpulmonary pressure using an esophageal monitor.
  D. Continue to ventilate this patient at the current settings until the lung compliance increases.

[essyface1]

Answer to Question 1

ANS: D
A. Incorrect response: See explanation D.
B. Incorrect response: See explanation D.
C. Incorrect response: See explanation D.
D. Correct response: If an inappropriate respiratory drive exists, or if patient triggering is uncomfortable, sedation or paralysis or both may be needed. However, unless the patient is grossly dyssynchronous with the ventilator despite every effort to make ventilation comfortable, paralysis to eliminate muscle activity should be avoided. Similarly, strategies that routinely employ paralysis and controlled ventilation to reduce O2 consumption should also be avoided because the potential decrease in O2 consumption is generally small, and the risk of long-myopathy from neuromuscular blockers is substantial

Answer to Question 2

ANS: C
A. Incorrect response: See explanation C.
B. Incorrect response: See explanation C.
C. Correct response: If a severely reduced chest wall compliance is present, its effects on Pplateau need to be considered empirically or else the transpulmonary pressure should be directly measured using an esophageal pressure monitor.
D. Incorrect response: See explanation C

[Marty]

Excellent

[scottmt]

Thanks for the timely response, appreciate it