Question 1

Which the following are hazards associated with mechanical ventilation?
1) Reduced cardiac output
2) Liver failure
3) Increased work of breathing
4) Acute lung injury

Accepted Answer

1) Reduced cardiac output - mechanical ventilation may reduce venous return and preload leading to reduced cardiac output
3) Increased work of breathing - mechanical ventilation can cause patient-ventilator asynchrony, leading to increased work of breathing
4) Acute lung injury - mechanical ventilation can cause barotrauma, volutrauma, or oxygen toxicity leading to acute lung injury. Liver failure (option 2) is not typically associated with mechanical ventilation.

Question 2

Which of the following clinical findings is least likely to be seen in a patient with acute hypoxic respiratory failure?

Accepted Answer

Clinical manifestations of acute hypoxemia and acute ventilatory failure are listed in Table 48-6.

Question 3

To stabilize a patient during the initial application of ventilatory support, which of the following parameters must be set? 1) Airway temperature 2) Ventilatory support mode 3) O₂ concentration (FiO₂) 4) Minute ventilation (f, V_T)

Accepted Answer

1) Airway temperature is important for patient comfort but not essential for stabilizing the patient during the initial application of ventilatory support. 2) Ventilatory support mode is crucial for stabilizing the patient. 3) O₂ concentration (FiO₂) is crucial for stabilizing the patient as it determines the amount of oxygen delivered to the patient. 4) Minute ventilation (f, V_T) is important but not essential for stabilizing the patient during the initial application of ventilatory support.

Question 4

In which of the following clinical conditions would noninvasive ventilation (NIV) be recommended?
1) Management of acute exacerbation of chronic obstructive pulmonary disease (COPD)
2) Management of premature extubation
3) Management of cardiogenic pulmonary edema
4) Management of acute respiratory distress syndrome (ARDS)

Accepted Answer

NIV is recommended for management of acute exacerbation of COPD, management of premature extubation, and management of cardiogenic pulmonary edema.

Question 5

Which of the following modes of ventilatory support would you recommend for a patient who can breathe spontaneously and only requires assistance to overcome the work of breathing created by the ET tube?

Accepted Answer

PSV can reduce work of breathing and may improve patient ventilator synchrony by placing more control with the patient. Many clinicians use PSV simply to overcome WOB imposed by the artificial airway.

Question 6

Compared with a volume-cycled strategy, what are some potential advantages of pressure-targeted ventilatory support?
1) Limit and control of peak airway pressures
2) Direct control over inspiratory time
3) Provision of a decelerating flow pattern

Accepted Answer

Pressure-targeted ventilatory support limits and controls peak airway pressures to prevent barotrauma and provides a decelerating flow pattern, which can improve gas exchange. Direct control over inspiratory time is not a unique advantage of pressure-targeted modes as it can be adjusted in both volume-cycled and pressure-targeted ventilation.

Question 7

What percentage of mechanical ventilated patients has a tracheostomy tube place at some point?

Accepted Answer

Approximately 5% to 10% of patients receiving mechanical ventilation have a tracheotomy performed at some point.

Question 8

Which of the following is the least frequent cause of acute respiratory failure needing mechanical ventilation?

Accepted Answer

The most common causes of acute respiratory failure that necessitate mechanical ventilation are listed in Table 48-1.

Question 9

Which of the following is an advantage of Pressure Control Ventilation?

Accepted Answer

Box 48-5 summarizes the Advantages and Disadvantages of Pressure Control Ventialtion.

Question 10

What goal(s) does the practitioner hope to achieve when selecting initial ventilatory support settings?
1) Optimize oxygenation.
2) Optimize ventilation.
3) Maintain acid-base balance.
4) Avoid harmful side effects.

Accepted Answer

When selecting initial ventilatory support settings, the practitioner hopes to achieve all four goals listed, which are to optimize oxygenation, optimize ventilation, maintain acid-base balance and avoid harmful side effects. Therefore, choice D is the correct answer.

Question 11

Compared to a pressure-controlled strategy, what is the primary advantage of volume-controlled ventilatory support?

Accepted Answer

The primary advantage of volume-controlled ventilation is maintenance of a stable minute ventilation in the face of changing lung mechanics.

Question 12

Which of the following is one of the modes of ventilation that may be considered when partial ventilatory support is indicated?

Accepted Answer

Normally, when partial ventilatory support is indicated, IMV, PSV, volume support, PAV, and NAVA are the modes of choice.

Question 13

Which of the following findings would you expect to see in a patient who has acute ventilatory failure with severe hypercapnia?

Accepted Answer

Clinical manifestations of acute hypoxemia and acute ventilatory failure are listed in Table 48-6.

Question 14

Which of the following represents a clinical situation where partial ventilatory support is commonly used?

Accepted Answer

Partial ventilatory support techniques may be especially useful for weaning patients from mechanical ventilatory support, and pressure-supported ventilation (PSV) and synchronized intermittent mandatory ventilation have been used as partial support strategies for weaning.

Question 15

Which of the following situations is most likely to call for ventilator settings of low volume and high rate while allowing for permissive hypercapnia?

Accepted Answer

Ventilation strategies for lung protection in ARDS include a low VT, rapid respiratory rates, and permissive hypercapnia if necessary to avoid overdistention or P_plat greater than 28 cm H₂O.

Question 16

If the patient is being ventilated via a mechanical ventilator via intermittent mandatory ventilation with partial ventilatory support, what would probably happen to PaCO₂ if the patient suddenly had no spontaneous breathing?

Accepted Answer

With partial ventilatory support, if spontaneous breathing ceases or becomes inadequate, as may be the case with the development of rapid shallow breathing or apnea, alveolar ventilation may decrease, and PaCO₂ may increase above an acceptable level.

Question 17

Physiological goals of artificial ventilatory support include which of the following?
1) Support or manipulate gas exchange.
2) Reduce or manipulate the work of breathing.
3) Increase lung volume.

Accepted Answer

The physiological goals of artificial ventilatory support include support or manipulation of gas exchange, reduction or manipulation of the work of breathing, and an increase in lung volume. All three of these goals can help improve respiratory function and oxygenation in patients with respiratory failure or other respiratory disorders. Therefore, all options are included in the answer.

Question 18

Which of the following are advantages of Assist Control Volume ventilation?
1) Minimal safe level of ventilation achieved.
2) Patient can set breathing rate.
3) May reduce work of breathing.
4) Pressure is limited.

Accepted Answer

Assist Control Volume ventilation provides a minimal safe level of ventilation and may reduce the work of breathing for the patient. Additionally, the patient can set the breathing rate. However, pressure is not limited with this mode of ventilation. Therefore, options 1, 2, and 3 are correct, but option 4 is incorrect. Thus, the best choice is B, which includes options 1, 2, and 3.

Question 19

After starting volume-cycled mechanical ventilation on a patient in respiratory failure with a V_T of 10 ml/kg, you measure and obtain a plateau pressure of 45 cm H₂O. Which of the following actions would you recommend to the patient's physician?

Accepted Answer

Plateau pressure (P_plat) during mechanical ventilation reflects alveolar pressure, the best bedside clinical reflection of transalveolar pressure. Limiting P_platreduces the likelihood of ventilator-induced lung injury, although patients with decreased thoracic compliance may require plateau pressures greater than 30 cm H₂O without resulting overdistention.

Question 20

What is the recommended range for the tidal volume for the initial ventilator settings in the volume control mode in a patient with normal lungs?

Accepted Answer

Tidal volume of 6 to 8 ml/kg of ideal body weight.

Quiz 48: Initiating and Adjusting Invasive Ventilatory Support

Which the following are hazards associated with mechanical ventilation? 1) Reduced cardiac output 2) Liver failure 3) Increased work of breathing 4) Acute lung injury

Which of the following clinical findings is least likely to be seen in a patient with acute hypoxic respiratory failure?

To stabilize a patient during the initial application of ventilatory support, which of the following parameters must be set? 1) Airway temperature 2) Ventilatory support mode 3) O2 concentration (FiO2) 4) Minute ventilation (f, VT)

Which of the following modes of ventilatory support would you recommend for a patient who can breathe spontaneously and only requires assistance to overcome the work of breathing created by the ET tube?

Compared with a volume-cycled strategy, what are some potential advantages of pressure-targeted ventilatory support? 1) Limit and control of peak airway pressures 2) Direct control over inspiratory time 3) Provision of a decelerating flow pattern