Exam 13: Improving Oxygenation and Management of ARDS

What is the optimal PEEP level given the following information? Time 0600 0615 0625 0635 0640 0650 0 5 8 10 12 15 =0.6 50 62 75 81 86 103 / 16 21 28 38 34 30 140/90 130/90 120/90 120/90 118/80 100/70

Assessing the outcome of PEEP at levels set above 15-20 cm H₂O is best done using which of the following?

During a patient case study,increasing increments of PEEP showed no significant effects until 15 cm H₂O was used,at which time the PₐO₂ improved markedly.This represents the point at which _______________.

A patient with extensive infiltrates throughout the right lung should be placed in which of the following positions to improve oxygenation?

To perform a slow-flow (quasi-static)technique for determining the appropriate PEEP level,the most appropriate ventilator flow setting is which of the following?

"Loose atelectasis," or compression atelectasis,is most often associated with _____________.

Which of the following is the most appropriate PEEP level for the patient whose information is in the table below?

How long after PEEP is increased should all ventilatory and available hemodynamic parameters be measured and calculated?

Calculate the pulmonary shunt fraction for a patient with the following data: Pb = 760 mm Hg; Hb = 10 g/dL; respiratory quotient = 0.8; FɪO₂ = 0.6; PₐO₂ = 100 mm Hg; SₐO₂ = 93%; PₐCO₂ = 45 mm Hg; = 36 mm Hg; = 70%.

A recruitment maneuver (RM)is being performed on a patient receiving mechanical ventilation with PCV.During the maneuver the mode remains in PCV,rate = 10/min,I:E = 1:2,and PIP = 35 cm H₂O.The following information is documented during the RM: Time 0800 0805 0810 0815 0820 0825 0830 0835 0840 PEEP 10 15 20 25 30 25 20 15 10 Static Eampliance 24 29 34 25 22 27 31 36 32 EP 126/68 124/66 118/58 110/55 106/58 112/60 118/62 115/60 117/62 HR 108 108 105 100 100 102 105 106 105 After the RM,the lungs are reinflated.At what level should the PEEP be set for this patient?

Thirty minutes after intubation and initiation of mechanical ventilation,a patient's PₐO₂ = 55 mm Hg and the FɪO₂ = 0.5.To what should the FɪO₂ be set to obtain a PₐO₂ of 80 mm Hg?

An absolute contraindication to PEEP is which of the following?

Despite the risk,it is still important to use PEEP,because it can prevent alveolar collapse during exhalation and reopening,even when a low Vᴛ is used.It now is theorized that it is important to use the pressure-volume loop to set PEEP _____________________.

The highest pressure attained during the slow-flow (quasi-static)technique should be ______ cm H₂O.

During mechanical ventilation of a patient with COPD,the PₐO₂ = 58 mm Hg and the FɪO₂ = 0.5.If the desired PₐO₂ is 65 mm Hg,the FɪO₂ needs to be changed to which of the following?

Calculate the pulmonary shunt fraction using the following data: Pb = 757 mm Hg; hemoglobin (Hb)= 11 g/dL; FɪO₂ = 0.5; PₐO₂ = 86 mm Hg; PₐCO₂ = 40 mm Hg; SₐO₂ = 91%; = 40 mm Hg; = 71%; respiratory exchange quotient (R)= 0.8.

An invasively ventilated patient with ARDS is on PC-CMV,PIP = 30 cm H₂O,PEEP = 12 cm H₂O,FɪO₂ = 1.0.The patient's returned Vᴛ is 320 mL.The ABG results on these settings are: pH 7.3,PₐCO₂ 53 mm Hg,PₐO₂ 62 mm Hg.The patient is placed in the prone position,and after 1 hour,ABG results show: pH 7.38,PₐCO₂ 46 mm Hg,PₐO₂ 83 mm Hg.The respiratory therapist should do which of the following?

The "sigmoid" shape of the static pressure-volume lung recruitment maneuver indicates which of the following?

Regardless of the procedure used to establish an appropriate PEEP level,ventilating pressures should not be allowed to exceed which of the following?

Calculate the pulmonary shunt fraction for a patient with the following data: CᴀO₂ = 17 vol%; CₐO₂ = 16.5 vol%; = 11 vol%.