Question Answer
A(n)is a device that provides a constant pressure throughout expiration regardless of the rate of gas flow or ventilation (ie flow independent) threshold resistor
During mechanical ventilation of a patient with CHF, the PaO2= 38mmHg and the FIO2= 0.60. If the desired PaO2 is 60, then the FIO2 must be changed to 0.95
Several types of recruitment maneuvers are currently being used in the clinical setting. These include a sustained high pressure in the CPAP mode, PCV with a single high PEEP level imposed, PCV with progressive increases in PEEP level, and sigh maneuvers TRUE
If the PAOP rise markedly as PEEP increases, the lungs may be over-inflated. PEEP may need to be increased FALSE
Atelectasis is the partial or complete collaspe of previously expanded areas of the lung, producing a shrunken, airless state. It may be caused by all of the following Blockage of air passages, shallow breathing with increased FIO2, and Surfactant deficiency
It is important to try and keep FIO2 below 0.4 and 0.5 to prevent the complications of O2 toxicity, while keeping the partial pressure of O2 in the arteries (PaO2) between 60 and 90 mmHG and the CaO2 near normal (20 mL/dL) TRUE
The level of PEEP set must be balanced against producing profound cardiopulmonary side effects such as decreased venous return, decreased cardiac output, decreased blood pressure, increased shunting, increased VD/VT, barotrauma, and volutraum TRUE
An increased in PEEP that increases the P(a-et)[email protected] gradient past its minimum represents a PEEP that can be expected to produce a drop in cardiac output and an increase in dead space-to-tidal volume (VD/VT) ratio TRUE
The O2 saturation measured by a pulse oximeter (SpO2) is only an estimate that cannot be used to titrate FIO2 FALSE
Patients’ clinical conditions that indicate that PEEP or CPAP therapy be started as soon as possible include all of the following conditions High peak pressure (> 35cm H2O), Pathological conditions wiht FIO2 values = 0.5, and Pathological conditions that damage pulmonary cells (types I and II)
The three marjor oxygenation strategies employed during mechanical ventilation include manipulation of all of the following Mean airway pressure, PEEP, and FIO2
Despite risk, it is still important to use PEEP, since it can prevent alveolar collapse during exhalation and reopening even when a low VT setting is used. It is now theorized that it is important to use the pressure-volume loop to set PEEP_________. above the upper inflection point detected during deflation of the lung
In primary ARDS (direct), lungs are mostly consolidated. In secondary ARDS (indirect), alveolar collapse is predominant. A lung recruitment maneuver is less likely to improve oxygenation and compliance of the lung in secondary ARDS FALSE
The use of PEEP allows for the reduction of FIO2 because PEEP improves oxygenation and helps to avoid the complications associated with a high FIO2 in certain disorders specific clinical disorders that may benefit from the use of PEEP incld all of ALI or ARDS, cardiogenic pulmonary edema, and bilateral diffuse pneumonia
PEEP is absolutely contraindicated in which of the following Untreated tension pneumothorax
A clinician is asked to reduce the PEEP that the patient has been receiving from 10 to 5 cm H2O, using an older ventilator. After the adjustment is made, the ventilator begins initiating inspiration spontaneously.. best explain this malfunction? The sensitivity control needed to be reset after PEEP was adjusted.
If cardiac output is low, O2 transport may be enhanced by all of the following methods except ____. using beta-blocking agents
Factors that increase Paw during PPV include all of the following except ____. increased FIO2
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 ____. alveolar recruitment probably occurred
The positive pressure employed with CPAP or PEEP is commonly applied to the airway with all of the following devices except ____. esophageal obturator
A pt is receiving 10PEEP with an FIO2 of 0.40 The pt is hypoxemic and the clinician decides to increase the PEEP to 15 and maintain the FIO2. The subsequent cardiac output measurement shows a change from 4.5 t02.7 L/min. The appropriate action is to ____. apply PEEP at 10 cm H2O and maintain the FIO2 at 0.50
During mechanical ventilation of a patient with COPD, the PaO2 = 58 mm Hg and the FIO2 = 0.50. If the desired PaO2 is 65, then the FIO2 must be changed to ____. 0.56
The ARDS Network and other studies provide strong evidence in support of using VT of 6 mL/kg and a PPlateau <30 cm when ventilating patients with ARDS. The difference in survival are significant when these settings are used compared with using a VT of 12 TRUE
Which of the following statements is true about prone-positioning of patients with ARDS? It produces a transient improvement in gas exchange.
Which of the following is not a common finding in the exudative phase of ARDS? Bradypnea
Which of the following benefits has not been associated with the use of PEEP in a patient with ARDS? Improved venous return
What ventilatory strategy has been found to be useful for avoiding barotrauma in the treatment of patients with ARDS? Permissive hypercapnia
What is recommended in terms of fluid management of patients with ARDS? Conservative
The mortality rate for patients with acute respiratory distress syndrome (ARDS) has remained stable over the past two decades. FALSE
What characteristic of a patient with ARDS suggests that the use of inhaled nitric oxide might be useful? Severe elevation of pulmonary vascular resistance.
Which of the following parameters is important in determining the optimal level of positive end-expiratory pressure (PEEP) in a patient with ARDS? DO2
What time does the exudative phase of ARDS typically presents? Between days 1 and 3
Which of the following terms describes programmed cell death? Apoptosis
The lungs of a patient with ARDS are effectively reduced to 20% to 30% of their normal size. TRUE
Which of the following clinical features is often common to both ARDS and congestive heart failure (CHF)? Diffuse alveolar and interstitial infiltrates in chest radiograph
Distinguishing between hydrostatic and nonhydrostatic pulmonary edema is often difficult, even for skilled clinicians. TRUE
Although promising, inhaled NO remains an experimental therapy for patients with ARDS. TRUE
What mode of mechanical ventilation is designed to optimize ventilation by recruiting alveolar units while minimizing ventilator-induced barotrauma in patients with ARDS? Airway pressure-release ventilation (APRV)
Which of the following assessment tools is most useful in distinguishing ARDS from CHF? Swan-Ganz catheter
Which of the following tests provides useful information in making the diagnosis of ARDS for patients with inconclusive results on traditional tests? Examination of bronchoalveolar lavage fluid (BALF).
What mode of mechanical ventilation is designed to optimize ventilation by reducing alveolar collapse while using small tidal volumes in patients with ARDS? High-frequency ventilation (HFV)
Which of the following risk factors for ARDS is considered a secondary risk factor? Sepsis
Which of the following organs plays a major role in induction and modulation of the systemic inflammatory response? Liver
What is the maximal inspiratory pressure that should be targeted when using pressure control ventilation in patients with ARDS? 30 to 35 cm H2O
What range is now recommended for tidal volumes (VT) in a patient with ARDS who is being mechanically ventilated? 5 to 7 ml/kg
Which of the following white blood cells is most commonly implicated in the inflammatory process of ARDS? Neutrophils
Which of the following mechanisms ultimately leads to ARDS regardless of the etiology? Disruption of the endothelial and epithelial barriers.
According to the Starling’s equation, which forces influence the movement of fluid from the bloodstream to the interstitium? Microvascular hydrostatic pressure and Interstitial osmotic pressure
The routine use of extracorporeal membrane oxygenation (ECMO) in the treatment of patients with ARDS is not recommended at this time. TRUE
Which of the following complications has been associated with the use of PEEP in patients with ARDS? Reduced cardiac output
What is the name of the period that follows the exudative phase in ARDS? Fibroproliferative
Which of the following systems is the primary operant to rid the body of fluid accumulation in nonpathologic conditions? Lymphatic
Which of the following parameters are important in the management of patients with ARDS? Keep hemoglobin saturation above 90%, Ensure adequate urine output, and Keep mean arterial pressure above 60 mm Hg.
Which of the following are the minimum performing characteristics of most noninvasive ventilators? Inspiratory pressure of 30 cm H2O or less, PEEP of 15 cm H2O or less, and Inspiratory flow of 180 L/min or less at 20 cm H2O
Which of the following are contraindications for the use of noninvasive positive-pressure ventilation (NPPV)? Nonsupportive family Lack of financial resources, Copious amounts of secretions, and Uncooperative behavior on the part of the patient
What patient population is the only group currently accepted for the use of noninvasive positive-pressure ventilation (NPPV) in the hospital ward? Chronic obstructive pulmonary disease (COPD) patients with near normal pH
What strategy should be used when the patient complains of nasal congestion during the use of a nasal mask for noninvasive positive-pressure ventilation (NPPV)? Add a heated humidifier
NPPV is considered a life-saving application that offers a number of benefits over IPPV. Least significant among these is the avoidance of intubation. FALSE
When patients with CPE do not respond to conventional pharmacological and O2 therapy, the application of mask CPAP with O2 has not been found to be effective in expanding fluid-filled alveoli. FALSE
Which level of positive end-expiratory pressure (PEEP) is necessary to prevent rebreathing of carbon dioxide? 3 to 5 cm H2O
Initiating noninvasive positive-pressure ventilation (NPPV) can be done in the following settings emergency department, intensive care unit, hospital ward
Which of the following interfaces should be used in greater than 90% of the patients with hypoventilation? Full face mask
Which of the following is likely to occur when decreasing the expiratory positive airway pressure in the patient being ventilated using noninvasive positive-pressure ventilation? Increased tidal volume
The role of NPPV in the treatment of advanced cystic fibrosis has not been precisely determined; however, NPPV definitely ____ in some patients with cystic fibrosis who experience acute exacerbations of their disease process. Increases tidal volume
Which of the following therapies should be considered as first line of therapy in patients with exacerbation of chronic obstructive pulmonary disease (COPD)? Noninvasive positive-pressure ventilation (NPPV)
Which of the following is the current recommendation for adding humidity while using noninvasive positive-pressure ventilation (NPPV)? It is recommended for long-term application (longer than 1 day).
Which of the following is the most important advantage of noninvasive ventilators over other types of ventilators? Ability to trigger and cycle appropriately when small to moderate air leaks are present
Abdominal displacement ventilation works on the principle of moving the abdominal contents and diaphragm to facilitate breathing. True
The three basic methods of applying noninvasive ventilation include all of the following except ____. transpleural insufflation
Which of the following techniques is NOT useful to avoid claustrophobia in the patient being ventilated by face mask? Use a larger mask
Physiological criteria for commitment to NPPV include all of the following except ____. SaO2 <92%
Which of the following groups of patients is NOT considered at risk for reintubation? Patients older than 45 years
Which of the following define successful application of noninvasive positive-pressure ventilation (NPPV)? Overall improvement of patient’s blood gas, Normal blood gas, and PaO2 increased
Symptoms and selection criteria for NPPV in acute respiratory failure include all of the following except ____. purse-lipped breathing
Which of the following groups of patients with nocturnal hypoventilation respond to noninvasive positive-pressure ventilation (NPPV)? Hypercarbic
Which of the following interfaces appear to be more efficient to improve ventilation? Nasal pillows, Full face mask
Your patient is being ventilated with a nasal mask to relieve dyspnea. He has a long history of chronic obstructive pulmonary disease and hypercarbia. What is the goal of noninvasive positive-pressure ventilation in this settting with regard to the ABGs? Return the PaCO2 to less than 60 mm Hg.
All of the following are potential benefits of using noninvasive positive-pressure ventilation (NPPV) during weaning except reduced incidence of pulmonary embolism
Which of the following does not predict successful use of noninvasive positive-pressure ventilation (NPPV) in the respiratory failure patient? pH = 7.20
What complication associated with noninvasive positive-pressure ventilation (NPPV) is most common? Air leaks
Which of the following ventilators is not used for noninvasive positive-pressure ventilation (NPPV)? Negative pressure
The use of noninvasive positive-pressure ventilation (NPPV) in the long-term care of patients with chronic obstructive pulmonary disease (COPD) will benefit the patient in all the following ways except: resetting the respiratory center to better respond to hypoxemia.
NPPV can be useful in chronic cases as supportive therapy for all the following clinical disorders except ____. metabolic disorders leading to acidosis
Endotracheal intubation is associated with all of the following complications except ____. choanal atresia
Other noninvasive devices developed to assist ventilation and to facilitate weaning from an iron lung or tank ventilator include all of the following except ____. the Emerson oscillator
Which of the following ventilators is generally only used for chronic noninvasive positive-pressure ventilation (NPPV)? Portable
Which of the following indications for noninvasive positive-pressure ventilation (NPPV) is where the greatest controversy exists? Hypoxemic respiratory failure
Which of the following is NOT a goal of noninvasive positive-pressure ventilation (NPPV) in the acute care setting? Improved mobility
NPPV can be useful in chronic cases as supportive therapy for all the following clinical EXCEPT metabolic disorders leading to acidosis
PEEP is absolutely contraindicated in which of the following Untreated tension pneumothorax
What mode of mechanical ventilation is designed to optimized ventilation by reducing alveolar collaspe while using small tidal volumes in patients with ARDS High-frequency ventilation (HFV)
Which of the following devices is considered to be the first electrically powered negative pressure ventilator The iron lung
Compared with nasal masks, full-face masks are associated with all of the following, EXCEPT hypocapnia
When patients with CPE do not respond to conventional pharmacological and O2 therapy, the application of mask CPAP with O2 has not been found to be effective in expanding fluid-filled alveoli FALSE
Which of the following restrictive thoracic diseases are successfully managed with noninvasive positive-pressure ventilation (NPPV) Postpolio syndrome, neuromuscular disease, spinal cord injury, and severe kyphoscoliosis
Which of the following findings is NOT an exclusion criterion for using noninvasive positive-pressure ventilation (NPPV) in the patient with acute respiratory faliure? Low risk of aspiration
Endotracheal intubation is associated with all of the following complications EXCEPT choanal atresia
The mortality rate for patients with acute respiratory distress syndrome (ARDS) has remained stable over the past two decades. FALSE
Which of the following interfaces appear to be more efficient to improve ventilation Nasal pillows, full face mask
The use of PEEP allows for the reduction of FIO2 because PEEP improves oxygenation and helps to avoid the complications associated with a ^ FIO2 in certain disorders. disorders that may benefit from the use of PEEP include all of the following EXCEPT Carbon monoxide poisoning
Distinguishing between hydrostatic and nonhydrostatic pulmonary edema is often difficult even for skilled clinicians TRUE
Disorders associated with nocturnal hypoventilation that generally benefit from NPPV include all of the following EXCEPT pulmonary fibrosis
What it the maximal inspiratory pressure that should be targeted when using pressure control ventilation in patients with ARDS 30 to 35 cm H2O
What ventilatory strategy has been found to be useful for avoiding barotrauma in the treatment of patients with ARDS Permissive hypercapnia
Your patient is being ventilated with a nasal mask to relieve dyspnea. He has a long history of COPD and hypercarbia. What is the goal of noninvasive positive-pressure ventilation in this setting with regard to the ABGs? Return the PaCO2 to less than 60 mmHG
Which of the following systems is the primary operant to rid the body of fluid accumulation in nonpathologic conditions Lymphatic
Why did the use of intermittent positive-pressure breathing declined in the 1980s? Due to the lack of scientific evidence to support its use for delivering aerosolized medication
Which of the following organs plays major role in induction and modulation of the systemic inflammatory response? Liver
How does noninvasive positive-pressure ventilation (NPPV) benefit the patient with restrictive thoracic disease Rests the respiratory muscles, lowers the PaCO2, Improves lung compliance
Although invasive ventilation is effective and often nescessary to support alveolar ventilation, it has many associated risks that often result in increased mortality, morbidity, and financial cost TRUE
Which of the following is a potential risk of over tightening the straps of the mask? Tissue necrosis
NPPV is considered a life-saving application that offers a number of benefits over IPPV. Least significant among these is the avoidance of intubation FALSE
Which of the following ventilators is not used for noninvasive positive-pressure ventilation (NPPV) Negative pressure
Which of the following interfaces should be used in greater than 90% of the patients with hypoventilation Full face mask
The use of NPPV in the long-term care of patients with COPD will benefit the patient in all of the following ways EXCEPT resetting the respiratory center to better respond to hypoxemia
Which of the following is NOT a required ventilator alarm for NPPV? Blender alarm
The routine use of extracorporeal membrane oxygenation (ECMO) in the treatment of patients with ARDS is not recommended at this time TRUE
Which level of PEEP is necessary to prevent rebreathing of carbon dioxide 3 to 5 cm H2O

Mechanical Ventilation Chapter 3 Practice Questions:

1. ____________is initiated and delivered by the ventilator when a preset time interval has elapsed. If a ventilator has a set frequency of 12 breaths per min., then the time triggering interval is what?: (a.) Time-triggered (b.) 5 sec. = 60 sec/12

2. ____________is initiated and delivered by the ventilator when it senses the patient’s spontaneous (negative pressure) inspiratory effort. The range of acceptable sensitivity levels is what?: (a.) pressure triggered (b.) -1 to -5 cm H20 below the patient’s baseline

3. ____________is the variable that determines the start of inspiration and __________,__________,_________,or___________can be used as a variable to initiate inspiration: (a.) trigger variable (b.) pressure (c.) volume (d.) flow (e.) time

4. ”Dual control breath to breath” is what. What 2 modes can the vent operate in?: (a.) Allows clinician to set a desired volume target and vent delivers pressure controlled breaths attempting to reach this target(b.) pressure support or pressure controlled

5. ”Dual control within a breath” implies what? During this mode_________controlled switches to___________controlled? The clinician sets___________which becomes a target volume during the breath. What is adjusted to maintain guaranteed tidal volume. Examples of this mode include what?: (a.) that two variables become control variables during inspiration within the same breath (b.) during dual mode the ventilator switches from pressure-controlled to volume-controlled (c.) Pressure (d.) pressure augmentation & volume assured pressure support

6. (IMV) allows the patient to do what: (1.) Breathe SPONTANEOUSLY between TIME-TRIGGERED ventilatory breaths. (2.) It can be VOLUME or PRESSURE controlled (3.) SPONTANEOUS breaths can be augmented using pressure support, which can increase patient TIDAL VOLUME and reduce WOB associated with the endotracheal tube’s resistance



7. 2 Examples of electrically powered ventilators include:_____________&_____________: (a.) Carefusion LTV 1150 (b.) Puritan Bennet 540

8. 2 Examples of ventilators pneumatically and electrically powered include:___________&____________: (a.) Viasys Avea (b.) Puritan Bennet

9. Application of________________&________________are used to increase (FRC): positive end-expiratory-pressure & Continuous positive airway pressure

10. Compliance is defined as change in volume divided by_________: pressure

11. Define volume-controlled ventilation? What is the advantage of volume control?: (a.) Clinician presets volume, but pressure varies (b.) both tidal volume can be augmented and minute volume, since tidal volume is a product of minute ventilation ( Vt x RR)

12. Describe Pressure-Limited Time Cycled Breaths. Pressure is adjusted in increments of what?: (a.) inspiration begins as pressure limited breaths (pressure increases to a set value or target) and they are time cycled (inspiration ends at specified time interval) pressure increases or decreases automatically to reach desired target volume. (b.) 1 – 3 cm H20 between breaths

13. During inspiration the primary____________cause the size of the ____________ to ______________: (a.) ventilatory muscles (b.) thoracic cage (c.) increase

14. Explain Pressure-Limited flow cycled breaths?: These breaths start out as pressure-support breath with a target tidal volume & inspiration is flow cycled

15. A flow controller does what? How is flow measured?: (a.) Allows pressure to vary with changes in the patient’s compliance & resistance while directly measuring and controlling flow. (b.) Pneumotachometers, strain gauge flow sensors

16. Flow is a unit of volume divided by a_____________: unit of time

17. A flow-triggered breath uses what strategy?: combines continuous flow and demand for flow mechanisms, and it is used to reduce inspiratory effort. Continuous flow passes through vent circuit and returns to the ventilator. Ventilator senses returned flow and instantly supplies enough flow to satisfy mechanical or spontaneous tidal volume.

18. Gas flows into lungs as a result of_______________pressure gradient: Trans-airway

19. How does pressure support augment spontaneous ventilation? Is flow variable in this mode? This mode assures what?: (a.) It increases tidal volume with the application of adjustable pressure. (b.) Yes (c.) Assures patient’s spontaneous breaths are large enough to maintain adequate blood gases

20. If a variable (pressure, flow, volume) is not allowed to rise above its preset value during inspiratory time it is termed________________: limit variable

21. If compliance worsens during volume controlled ventilation what will happen to peak inspiratory pressure and minute ventilation?: Peak inspiratory pressure terminates soon and the minute ventilation decreases, reducing VILI (ventilator-induced lung injury

22. Inspiration ends when a specific___________is reached: cycle variable

23. Mechanical ventilation mode is defined as a combination of what 3 things?: (1.) pattern (2.) control type (3.) operational algorithms

24. Pneumatically powered ventilators use____________as an energy source. 2 examples include:__________ &_____________: (a.) compressed gas source (b.) Bird Mark 7 (c.) Percussionaire IPV

25. A positive pressure ventilator does what? What equipment does it require? A negative pressure ventilator does what?: (a.) It applies positive pressure inside chest to expand it, which is greater than atmospheric (b.) tight fitting mask or endotracheal tube (c.) Applies sub-atmosphereic pressure outside of the chest to inflate lungs

26. The pressure required to deliver the tidal volume is referred to as the____________: Load

27. Pressure support is a variation of what?: It is a variation of spontaneous mode of ventilation that augments spontaneous effort with positive pressure support

28. The pressure-controlled ventilation does what?: Allow clinician to set peak inspiratory pressure, so volume and minute ventilation will change with change in compliance or resistance

29. Resistance is the force that must be____________to move gas through the_________________ which is best described by_____________: (a.) overcome (b.) conducting airways (c.) Poiseuille’s Law

30. Time Controllers are what?: ventilators that measure and control inspiratory and expiratory time and allows for pressure and volume to vary with changes in compliance and resistance

31. True or False? A mechanical ventilator can substitute fully or partially for ventilatory work: True

32. True or False? Pressure support is a spontaneous ventilation mode that is pressure or flow triggered?: True

33. The variable that is controlled during the expiratory phase or expiratory time is termed___________: Baseline variable

34. A ventilator is considered a___________if the ventilator control the______________system and the equation for this system is_______________: (a.) pressure controlled vent (b.) trans-respiratory (c.) Airway pressure – Body surface pressure

35. A ventilator supported breath are supported by what 4 distinct phases: (1.) Inspiration (2.) change from inspiration to expiration (3.) change from inspiration to expiration (4.) Expiration

36. A volume controller does what?: Allows volume to remain constant while pressure varies

37. What 4 primary variables can the ventilator control: (1) Pressure (2) Volume (3) Flow (4) Time

38. What does the drive mechanism do?: Transmits input power to useful ventilatory work

39. What is a controller: A mechanism that provides a mode of ventilation within a specific parameter

40. What is Airway pressure release Ventilation: it is a form of CPAP with two distinct pressure levels. It maintains spontaneous breathing. It is time triggered, pressure limited, and time cycled, which allows spontaneous breathing. Also, high and low pressures are set

41. What is automatic tube compensation?: is a mode that compensates for resistance of the endotracheal tube and pressure is applied based on size of tube and can reduce air trapping and intrinsic peep



42. What is Automode?: In absence of spontaneous patient effort, vent delivers mandatory breaths using a time-triggered, pressure-limited, time-cycled mode, adjusting pressure limit to maintain clinician set tidal volume.

43. What is proportional Assist Ventilation: is a mode in which the ventilator amplifies delivered pressure in proportion to measured inspiratory flow and volume & can be pressure or flow triggered and is cycled when patient’s volume and flow demands are met

44. What is the equation for volume?: Flow (L/Sec) X Inspiratory Time

45. Why must PEEP and CPAP be titrated carefully?: To monitor hemodynamic functions, blood gases, and compliance