A patient, who is nasally intubated, due to facial surgery, has ...

[ENagel]

A patient, who is nasally intubated, due to facial surgery, has been successful on her spontaneous breathing trial.
 
  She currently has moderate hypoxemia, despite a fractional inspired oxygen (FIO2) of 40 and positive end-expiratory pressure (PEEP) of 5 cm H2O while on volume-controlled continuous mandatory ventilation (VC-CMV). The most appropriate ventilator mode for this patient is which of the following?
  a. Airway pressure release ventilation (APRV)
  b. Continuous positive airway pressure (CPAP)
  c. Pressure support ventilation (PSV) with positive end-expiratory pressure (PEEP)
  d. Intermittent mandatory ventilation (IMV) with pressure support ventilation (PSV) and positive end-expiratory pressure (PEEP)

Question 2

A dual control mode provides pressure-limited ventilation with volume delivery targeted for every breath. If the desired volume is not met the ventilator will volume cycle. This describes which of the following ventilator modes?
 
  a. Airway pressure release ventilation (APRV)
  b. Pressure augmentation (Paug)
  c. MMV
  d. Pressure-regulated volume control (PRVC)

[asware1]

Answer to Question 1

ANS: D
The patient is ready to wean and can be placed on intermittent mandatory ventilation (IMV) to allow some ventilator breaths but also allow the patient to breathe spontaneously. The pressure support will help to overcome the increased airway resistance of the small endotracheal tube, due to the nasal intubation. The positive end-expiratory pressure (PEEP) will maintain oxygenation and keep the alveoli open.

Answer to Question 2

ANS: B
The pressure augmentation mode is a dual control mode that provides pressure-limited ventilation with volume delivery targeted for every breath. Each breath is flow cycled when the target vol-ume is reached. If the guaranteed volume is not achieved before flow drops to the set level, the ventilator maintains the flow at the set value until the volume is delivered, and at that point the ventilator volume cycles. Pressure-regulated volume control (PRVC) is similar in that it also tar-gets pressure and guarantees volume; however, when the set volume is not achieved the ventila-tor will incrementally increase pressure to achieve the volume.

[ENagel]

TYSM

[raenoj]

Excellent