Deck 15: Critical Care Issues in Mechanical Ventilation

Question 1

Patients with ARDS often lack cardiogenic signs of pulmonary edema such as cardiomegaly, pleural effusions, and vascular redistribution.

Answer 1

True

Question 2

Mechanical ventilation with low tidal volume increases dead space ventilation and alveolar ventilation.

Answer 2

False

Question 3

Patients who are admitted to the trauma, neurosurgical, or burn units have a higher incidence of VAP than in the respiratory units and medical ICUs.

Answer 3

True

Question 4

Brain cells cannot utilize fatty acids because they are not transported across the brain capillaries.

Question 5

The brain is contained within the skull, a rigid and non-elastic structure that has a capacity of about 1,000 mL.

Question 6

The four recommended evaluation parameters for the classification of ALI and ARDS are timing of onset, oxygenation, chest radiograph, and ____.

A) pulmonary artery pressure
B) pulmonary capillary wedge pressure
C) central venous pressure
D) arterial pressure

Question 7

Which of the following is a clinical condition associated with direct lung injury and development of ARDS?

A) near drowning
B) severe trauma
C) sepsis
D) drug overdose

Question 8

In the early stage of ARDS, the clinical signs may include tachypnea, ____, and mild hypoxemia.

A) hypotension
B) hypertension
C) tachycardia
D) bradycardia

Question 9

The primary advantage of using low tidal volume or permissive hypercapnia is to minimize the airway pressures and to reduce the risk for ____.

A) overdistention
B) air trapping
C) volutrauma
D) barotrauma

Question 10

During which of the following steps of the decremental recruitment maneuver should you initiate PCV at 15 cm H₂O and PEEP at 20 cm H₂O?

A) Step 2 - Continue sedation
B) Step 4 - Immediately after initial RM
C) Step 6 - Following initial RM
D) Step 7 - Optimum PEEP

Question 11

The risk of VAP is highest ____ of mechanical ventilation.

A) immediately after intubation and initiation
B) after 48 hours
C) after 5 days
D) after 2 weeks

Question 12

During the course of VAP, ____ is a common microbe seen in the first 48 hours.

A) Escherichia coli
B) Pseudomonas aeruginosa
C) Staphylococcus aureus
D) Streptococcus pneumonia

Question 13

Among the methods to prevent VAP, ____ is by far the simplest and most cost-effective way to reduce the incidence of VAP.

A) using proper cuff pressure to minimize the incidence of aspiration
B) early weaning from mechanical ventilation
C) proper and frequent hand washing
D) elevation of head of bed

Question 14

The brain is highly dependent on the constant supply of ____ provided by the blood.

A) glucose and fatty acids
B) oxygen and fatty acids
C) glucose and protein
D) oxygen and glucose

Question 15

During cerebral cellular injury and death as a result of energy deprivation, depolarization of the neuronal membrane causes ____.

A) failure of the Na⁺ and K⁺ pumps
B) neurons to release excessive glutamate into the synaptic cleft
C) activation of nitric oxide synthase
D) nitric oxide production to increase

Question 16

CPP is the difference between the ____ and intracranial pressure.

A) mean arterial pressure
B) pulse pressure
C) central venous pressure
D) end-diastolic pressure

Question 17

Traumatic brain injury ____ the ICP due to swelling of the brain which ____ the CPP.

A) decreases; increases
B) decreases; decreases
C) increases; increases
D) increases; decreases

Question 18

Systemic hypotension ____.

A) lowers MAP only
B) lowers ICP and CPP
C) lowers ICP only
D) lowers MAP and CPP

Question 19

Compression of the ____ suppresses the parasympathetic input to the eye resulting in a dilated pupil.

A) 3^rd cranial nerve
B) 7^th cranial nerve
C) 9^th cranial nerve
D) 12^th cranial nerve

Question 20

Which of the following levels of consciousness is used to describe someone who has a decrease in awareness and alertness, rouses briefly in response to stimuli, is unaware of the surroundings, and is unable to perform tasks or return to inactivity when left alone?

A) cloudy consciousness
B) lethargy
C) obtundation
D) stupor

Question 21

When non-homogenous lungs are ventilated by positive pressure, the non-compliant units are recruited intermittently while the compliant units suffer from _______________.

Question 22

The modified _______________ has been used as an additional aid in the diagnosis of VAP and decision on antimicrobial therapy.

Question 23

Cerebral perfusion pressure (CPP) is the pressure required to provide blood flow, oxygen, and _______________ to the brain.

Question 24

_______________ as a result of cardiac arrest is essentially a mechanical failure, whereas the heart is not generating adequate pressure to provide perfusion.

Question 25

_______________ is a type of brain injury that causes the downward displacement of the medial aspect of the temporal lobe (uncus) through the tentorial notch by a mass above.

Question 26

Discuss the lung protection strategy.

Question 27

What are the complications associated with permissive hypercapnia and how may they be alleviated?

Question 28

List five methods used to prevent VAP in mechanically ventilated patients.

Question 29

What are the symptoms in a mild and more advanced case of HIE?

Question 30

Explain the difference between acceleration and deceleration brain injuries.