Deck 15: Non-Invasive Mechanical Ventilation and Continuous Positive Pressure of the Neonate

Question 1

Which form of CPAP has been associated with a "thoracic wiggle"?

A)IF-CPAP (infant flow CPAP)
B)MV-CPAP (mechanical ventilator CPAP)
C)B-CPAP (bubble CPAP)
D)V-CPAP (ventilator-derived CPAP)

Answer 1

C
Subjective accounts of a visible "thoracic wiggle" from bubbles are often reported by clinicians caring for infants receiving B-CPAP.The use of higher flows can result in more vigorous bubbling and higher pressure fluctuations in the delivery system.However,higher flows do not appear to improve gas exchange.

Question 2

What is considered the most effective interface option for delivering CPAP to infants?

A)Binasal prongs
B)Nasal mask
C)Nasal pillows
D)Oronasal mask

Answer 2

A
Today,CPAP is most often administered through short binasal prongs,and this method is considered the most effective interface option for delivering CPAP to infants.

Question 3

After increasing the level of CPAP delivered to an infant,the therapist notices that the neonate's PaCO₂ rises and the PaO₂ falls.What may have caused this situation?

A)The Fio₂ was not increased sufficiently.
B)The CPAP level was not raised enough.
C)The CPAP level was raised too high.
D)A problem with the interface has likely developed.

Answer 3

C
A rise in PaCO₂ or fall in PaO₂ soon after the CPAP pressure has been increased may indicate that the optimal CPAP level has been exceeded.An increase in mean airway pressure can result in increased alveolar dead space because of mechanical compression of the pulmonary microvasculature.If gas exchange worsens in a patient who appeared to be improving,the CPAP pressure can first be reduced.If the patient's situation does not improve,endotracheal intubation and mechanical ventilation may be indicated.

Question 4

When nasal cannulas are used in infants at high flows,which factors determine the amount of pressure to the airways?
I)Flow rate
II)Size of the leak around the cannula
III)Degree of the mouth opening
IV)FiO₂

A)I and II only
B)III and IV only
C)II,III,and IV only
D)I,II,and III only

Question 5

Which of the following features are often components of CPAP systems incorporated within infant ventilators?
I)Highly responsive demand flow systems
II)Apnea backup breaths
III)FiO₂ compensation mechanisms
IV)Leak compensation capabilities

A)I and II only
B)II and III only
C)III and IV only
D)I,II,and IV only

Question 6

Where in the CPAP delivery system should the pressure-relief/pop-off valve be placed to detect circuit occlusion?

A)Anywhere along the exhalation limb
B)Anywhere along the inspiratory limb
C)Inside the ventilator
D)As close to the patient's airway as possible

Question 7

A preterm infant in respiratory distress is a candidate for CPAP.To minimize the work of breathing,which device should be used?

A)B-CPAP
B)IF-CPAP
C)Single probe CPAP
D)V-CPAP

Question 8

Which of the following therapeutic interventions would be appropriate for a neonate with a respiratory rate of 65 breaths/minute while displaying paradoxical chest wall movement with suprasternal and substernal retractions,grunting,nasal flaring,and cyanosis,along with the following blood gas data: pH 7.30;arterial partial pressure of carbon dioxide (PaCO₂),50 mm Hg;arterial partial pressure of oxygen (PaO₂),60 mm Hg?

A)Intubation and mechanical ventilation
B)High flow nasal cannula
C)Extracorporeal membrane oxygenation
D)Continuous positive airway pressure (CPAP)

Question 9

In order to rinse the system of exhaled CO₂ and meet the inspiratory flow rate requirements of infants placed on B-CPAP,the flow rate of humidified gas should be set at:

A)6 to10 L/minute
B)11 to 15 L/minute
C)16 to 20 L/minute
D)at least 15 L/minute

Question 10

Which of the following outcomes are advantages of CPAP over mechanical ventilation in infants?
I)Lower risk of sepsis
II)Lower incidence of lung injury
III)Fewer cases of chronic lung disease
IV)Lower incidence of renal failure

A)I and III only
B)II and IV only
C)I,II,and III only
D)II,III,and IV only

Question 11

Which of the following complications of CPAP can develop when an infant experiences inadvertent positive end-expiratory pressure (PEEP)from gas trapping resulting from tachypnea?

A)Pulmonary hypertension
B)Pneumothorax
C)Atelectasis
D)Diaphragmatic hernia

Question 12

After initiating IF-CPAP in an infant at 8 cm H₂O,the therapist notices a low-pressure alarm.What should be done to correct this situation?

A)Correct the leak by placing a chin trap.
B)Change to a smaller cannula.
C)Increase the flow through the CPAP system.
D)Change the flow generator.

Question 13

Which of the following anatomic structures should be closely evaluated when using nasal masks in the administration of IF-CPAP?

A)Tragus
B)Philtrum
C)Sphenoid axis
D)Lower lip

Question 14

After initiating B-CPAP in an infant at 6 cm H₂O,the therapist notices that,although "bubbling" is present,the pressure in the manometer fluctuates between 2 and 5 cm H₂O.What may have caused this situation?

A)The Fio₂ was not increased sufficiently.
B)The CPAP level was not raised enough.
C)The flow through the CPAP system is too low.
D)A problem with the interface has likely developed.

Question 15

How is the positive pressure level established in a bubble CPAP system?

A)The therapist dials the desired CPAP level directly on the ventilator.
B)The therapist immerses the distal end of the expiratory limb a certain distance below the water surface.
C)The CPAP level is established by stacking adaptors with weighted balls to the distal opening of the expiratory limb.
D)The positive pressure is achieved by tightening a screw clamp attached to the expiratory limb until the desired pressure is achieved.

Question 16

Which of the following conditions are contraindications for nasal CPAP?
I)Pneumonia
II)Tracheoesophageal fistula
III)Choanal atresia
IV)Atelectasis

A)I and II only
B)II and III only
C)III and IV only
D)I,II,and III only

Question 17

Which of the following CPAP systems delivers a more consistent pressure,lowers work of breathing (WOB),is less sensitive to leaks,and is more effective at alveolar recruitment compared with other forms of CPAP?

A)B-CPAP
B)MV-CPAP
C)V-CPAP
D)IF-CPAP

Question 18

How should a therapist determine the size of the nasal prongs to effectively administer CPAP to infants?

A)The prongs should occlude only 50% of the external nares diameter.
B)The prongs should occlude at least 75% of the external nares diameter.
C)The prongs should occlude 100% of the external nares diameter with minimal blanching.
D)The prongs should occlude 100% of the external nares diameter without blanching.

Question 19

A bubble CPAP has been set up on an infant at 12 L/min and the water column is reading 4 cm H₂O.A chest X-ray reveals mild lung overdistention.What is the most feasible explanation for this finding?

A)The amount of CPAP is excessive for this age group.
B)The flow rate is very high and the CPAP measured at the nasal prongs is probably > 4 cm H₂O.
C)The cannula is probably too large for the infant and causes inadvertent CPAP.
D)The chest X-ray finding is consistent with the amount of CPAP set at the water chamber.