A patient with ARDS has the slow pressure-volume loop shown ...

[wenmo]

A patient with ARDS has the slow pressure-volume loop shown below. Based on this loop, at what level should PEEP be set?
 
  a. 10 cm H2O
  b. 12 cm H2O
  c. 18 cm H2O
  d. 22 cm H2O

Question 2

Despite the risk, it is still important to use PEEP, because it can prevent alveolar collapse during exhalation and reopening, even when a low VT is used. It now is theorized that it is important to use the pressure-volume loop to set PEEP _______________
 
  a. at the upper inflection point detected dur-ing inflation of the lung
  b. above the upper inflection point detected during deflation of the lung
  c. at the lower inflection point detected dur-ing inflation of the lung
  d. at the peak inspiration point detected dur-ing inflation of the lung

[nhea]

Answer to Question 1

ANS: D
The rapid change in the slope of the deflation curve identifies the upper inflection point on the deflation portion of the curve as approximately 20 cm H2O. PEEP should be set 2-3 cm H2O above the upper inflection point, which is 22 cm H2O.

Answer to Question 2

ANS: B
Regardless of the procedure used to establish an appropriate PEEP level, ventilating pressures should not be allowed to exceed the UIP on the UIPi, because injury to lungs can occur if the lungs become overstretched. The appearance of the UIP on the graphic display may be influ-enced by the type of recruitment procedure used.

[wenmo]

Thanks for the timely response, appreciate it

[aliotak]

Excellent