The patient with which of the following assessment findings meets ...

[xclash]

The patient with which of the following assessment findings meets the criteria for beginning weaning from PEEP?
 
  a. PaO2 = 85 mm Hg; FIO2 = 0.6; Cs = 20 mL/cm H2O; PEEP = 12 cm H2O
  b. PaO2 = 100 mm Hg; FIO2 = 0.9; Cs = 22 mL/cm H2O; PEEP = 10 cm H2O
  c. PaO2 = 150 mm Hg; FIO2 = 0.7; Cs = 25 mL/cm H2O; PEEP = 12 cm H2O
  d. PaO2 = 95 mm Hg; FIO2 = 0.3; Cs = 30 mL/cm H2O; PEEP = 15 cm H2O

Question 2

A patient with extensive infiltrates throughout the right lung should be placed in which of the following positions to improve oxygenation?
 
  a. Left lung down laterally
  b. Right lung down laterally
  c. Left lung down with right lung 45 degrees from supine
  d. Right lung down with left lung 45 degrees from supine

[kkenney]

Answer to Question 1

ANS: D
The criteria for initiation of weaning from PEEP include: (1) an acceptable PaO2 (90 mm Hg) on an FIO2 0.4; (2) hemodynamic stability; (3) absence of sepsis; (4) improved CL (e.g., CS > 25 mL/cm H2O); and (5) PaO2/FIO2 ratio > 250 to 300. Choice A does not meet the minimum PaO2 or the minimum FIO2 and has a low Cs. Choice B has the appropriate PaO2, but the FIO2 is high and the Cs is low. Choice C has a high PaO2, but the FIO2 is 0.7, the calculated PaO2/FIO2 ratio is 214, and the compliance is just at the acceptable level. Choice D has all acceptable criteria, including a calculated PaO2/FIO2 ratio of 317.

Answer to Question 2

ANS: A
To improve oxygenation without uneven distribution of PEEP to the normal lung, the patient should be placed with the good lung down.

[xclash]

TYSM

[bbburns21]

Excellent