Author Question: While initially ventilating a patient with acute respiratory distress syndrome (ARDS), the ... (Read 33 times)

bobypop · **on:** Jul 16, 2018

While initially ventilating a patient with acute respiratory distress syndrome (ARDS), the extrin-sic positive end-expiratory pressure (PEEPE) should be maintained using which of the following methods?

a. 50 of intrinsic positive end-expiratory pressure (PEEPI)
b. Open lung approach
c. Offset intrinsic PEEP
d. Minimize mean airway pressure

Question 2

Sigh breaths could be beneficial during which of the following situations?

a. Continuous positive airway pressure (CPAP) used for the treatment of hy-poxemia.
b. Mechanical ventilation with VTS = 8-10 mL/kg.
c. Ventilating acute respiratory distress syn-drome (ARDS) patient with plateau pres-sure Pplateau >30 cm H2O.
d. Pressure-supported ventilation with tidal volume (VT) = 4-6 mL/kg

bigsis44 · **Reply #1 on:** Jul 16, 2018

Answer to Question 1

ANS: B
During the early phase of acute respiratory distress syndrome (ARDS), it is important to keep extrinsic positive end-expiratory pressure (PEEPE) high enough to at least exceed the inflection point on a slow or static pressure volume. It is generally accepted by clinicians that the deflation limb of a slow pressure-volume loop best approximates the end-expiratory pressure range required to prevent alveolar collapse. Maintaining PEEPE above this pressure range helps to prevent open-ing and closing of small airways and alveoli. This is referred to as the open lung approach to ven-tilatory management.

Answer to Question 2

ANS: D
Sigh breaths are not indicated for patients on continuous positive airway pressure (CPAP) for hypoxemia because it may be harmful. Sighs are not recommended for patients being ventilated with tidal volumes >7 mL/kg or in the presence of plateau pressures >30 cm H2O. Sighs may be beneficial to patients who are receiving pressure-supported ventilation and who have low tidal volumes with mild hypoxemia.