Deck 17: Mechanical Ventilation of the Neonate and Pediatric Patient

Question 1

The therapist is about to mechanically ventilate a neonate with a ventilator that delivers the volume guarantee mode.Which of the ventilator settings does the therapist need to set for this mode?
I)Minute ventilation
II)Tidal volume
III)Inspiratory time
IV)Inspiratory flow

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

Answer 1

D
Volume guarantee (VG)is another form of adaptive-control ventilation that is used in one type of neonatal ventilator.The operator sets a tidal volume,inspiratory time,and flow rate.This mode can also be applied to pressure support ventilation.The ventilator incorporates a proximal flow sensor at the patient airway.The microprocessor assesses an eight-breath historical average of expired tidal volume and will increase pressure on the basis of these measurements up to the pressure limit to deliver the target volume.

Question 2

Which of the following are indications for HFV?

A)Diffuse,heterogeneous lung disease
B)Existing pulmonary air leak syndrome
C)Severe bronchiolitis
D)PaO₂/Fio₂ ratio of 300

Answer 2

B
The bulk of clinical data regarding appropriate application of HFV devices has been acquired from neonatal humans and animals.From these studies,two clear indications for HFV use during either routine or rescue circumstances have evolved.They include diffuse,homogeneous lung disease (or the atelectasis-prone lung),in which LFV management is failing or may lead to increased risk of pulmonary morbidity,and existing pulmonary air leak syndromes (e.g. ,pneumothorax and PIE).

Question 3

During high-frequency ventilation,as the diameter of the ETT increases,what happens to the delivered tidal volume under the same pressure settings?

A)It does not change.
B)It increases.
C)It increases only if compliance changes.
D)It decreases.

Answer 3

B
As ETT dimensions and compliance decrease,so does tidal volume output from the HFV tested.This occurs in the presence of stable ventilator settings.Therefore any clinical change causing a decrease in ETT diameter,such as reintubation with a different-sized ETT or partial ETT obstruction with tracheal secretions,alters the delivered tidal volume in a direct proportion.Furthermore,improvements in lung compliance (e.g. ,volume recruitment)and decrements in lung compliance (e.g. ,patent ductus arteriosus or alveolar derecruitment)have a direct effect on tidal volume.

Question 4

During HFOV,which of the following factors has a direct influence on a neonate's delivered tidal volume?

A)Frequency
B)Oscillatory amplitude
C)Peak inspiratory pressure
D)IPAP (inspiratory positive airway pressure)and EPAP (expiratory positive airway pressure)

Question 5

Enhanced diffusion in HFV is a function of which of the following factors?

A)Inspiratory flow
B)Plateau pressure
C)Inspiratory time
D)Respiratory frequency

Question 6

During HFOV manipulation of which of the following components establishes the continuous distending pressure?

A)Gas flow through the pneumotachometer during expiration
B)Peak inspiratory pressure-trough pressure gradient
C)Inspiratory valve aperture
D)Bias flow

Question 7

Which of the following forms of mechanical ventilation is the most efficacious method for acquired bronchopleural fistulas?

A)High-frequency jet ventilation (HFJV)
B)High-frequency oscillatory ventilation (HFOV)
C)High-frequency flow interruption (HFFI)
D)Conventional ventilation (CV)

Question 8

When airway pressure release ventilation is used,what physiologic process occurs as the higher pressure is released and the lower is achieved?

A)Increased functional residual capacity
B)Increased tidal volume
C)Improved oxygenation
D)Exhalation of carbon dioxide

Question 9

Which of the following factors influences the gas volume compressed in the ventilator circuit?

A)Ventilation time constant
B)Water level in the humidifier
C)Location of the exhalation valve
D)Size (inner diameter)of the endotracheal tube

Question 10

How is the high-volume strategy achieved when the goal is to deliver a high lung volume to a neonate receiving HFV?

A)By increasing the continuous distending pressure
B)By reducing the peak-trough pressure gradient
C)By increasing the expiratory flow resistance
D)By decreasing the mean airway pressure

Question 11

While checking the ventilator of a pediatric patient,the therapist observes the following volume-time scalar:

What action should the therapist take at this time?

A)Increase the sensitivity setting.
B)Increase the tidal volume and increase the pressure setting.
C)Increase both the inspiratory flow and the pressure setting.
D)Check the patient-ventilator system for the presence of auto-PEEP.

Question 12

What frequency defines high-frequency modes of ventilation?

A)> 40 breaths per minute
B)> 100 breaths per minute
C)> 150 breaths per minute
D)> 200 breaths per minute

Question 13

The following pressure-volume loop was obtained from a patient receiving mechanical ventilation in the pressure support mode.What type of problem does this ventilator graphic represent?

A)Insufficient flow caused by insufficient driving pressure
B)Pressure sensitivity set inappropriately low
C)Excessive tidal volume
D)Increased mechanical dead space

Question 14

Which of the following factors need to be considered for HFV ventilator circuits?
I)Time for gas egress during exhalation
II)Circuit compliance
III)Endotracheal tube size
IV)Intrinsic timing mechanisms

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

Question 15

Which of the following modes of ventilation attempts to maintain a minimum target tidal volume with a constant pressure by manipulating the inspiratory flow?

A)Synchronized intermittent mandatory ventilation (SIMV)
B)Pressure support ventilation (PSV)
C)Volume-assured pressure support (VAPS)
D)Pressure-regulated volume control (PRVC)

Question 16

What is the recommended inspiratory time percent setting for HFOV?

A)20%
B)25%
C)33%
D)50%

Question 17

On the basis of the following flow/time scalar,which of the following conditions has developed?

A)Trigger dyssynchrony
B)Excess tidal volume
C)Air trapping
D)Ventilator circuit leak

Question 18

During volume-controlled ventilation,which of the following factors influences the peak inspiratory pressure?

A)Pulmonary capillary perfusion
B)Ventilation-perfusion relationships
C)Pulmonary compliance
D)Volume compressed in the ventilatory circuit at end inspiration

Question 19

What is a frequent requirement when employing the low-volume strategy while ventilating a neonatal patient with pulmonary interstitial emphysema by HFV?

A)High inspiratory flow
B)Positive end-expiratory pressure
C)High inspired fraction of oxygen (Fio?)
D)Longer inspiratory time

Question 20

Which of the following adjustments should the therapist consider to improve ventilation on a patient undergoing HFV?

A)Increase frequency
B)Increase $\overline{ { Paw }}$
C)Increase inspiratory time
D)Decrease frequency

Question 21

The therapist notices that gas exchange has dramatically improved in a neonate undergoing HFOV.However,weaning has not been implemented accordingly.What are the consequences of failing to quickly wean a neonatal patient from HFV?

A)Pulmonary overdistention
B)Pulmonary hypertension
C)Alveolar derecruitment
D)Decreased pulse rate

Question 22

Over the last 90 minutes,the therapist has obtained three arterial blood samples from an arterial line inserted in a neonate receiving mechanical ventilation and being monitored by capnometry.The PaCO? values were as follows: (1)47 mm Hg,(2)46 mm Hg,and (3)47 mm Hg.How should the therapist evaluate the following capnogram?
B

A)Abrupt disconnection from mechanical ventilation
B)Damped waveform caused by severe airflow obstruction
C)Reduced pulmonary blood flow caused by overdistention of the lungs
D)Secretions partially obstructing the sample line leading to the capnometer

Question 23

Why may HFOV be considered a suboptimal ventilation strategy for patients who have either fresh particulate meconium aspiration or bronchopulmonary dysplasia?

A)Ventilation time constants will be decreased.
B)Large increases in tidal volume delivery can occur.
C)Gas trapping may develop.
D)Intrapulmonary shunting becomes likely.

Question 24

How is the minute ventilation decreased when a patient is being weaned from HFOV?

A)By decreasing peak pressure
B)By reducing oscillatory amplitude
C)By minimizing $\overline{ { Paw }}$
D)By shortening the inspiratory time

Question 25

The therapist is conducting a ventilator check for a neonate and makes the following notations on the ventilator flow sheet:
•PEEP: 5 cm H₂O
•Peak inspiratory pressure (PIP): 25 cm H₂O
•Mandatory rate: 15 breaths/minute
•FiO₂: 0.35
On the basis of these observations,what should the therapist recommend for this neonate?

A)Shunt study
B)Weaning from mechanical ventilation
C)Inhaled nitric oxide
D)High-frequency ventilation

Question 26

On the basis of the following pressure-volume loop,what ventilator setting change should the therapist make?

A)Check the inflation pressure on the endotracheal tube cuff.
B)Increase the pressure limit.
C)Increase the delivered tidal volume.
D)Increase the inspiratory flow.

Question 27

Which of the following actions should a therapist consider in a patient suspected of having an airway obstruction while receiving HFV?

A)Observe the patient's chest wall for movement.
B)Increase conventional ventilation.
C)Increase mean airway pressure on the HFV.
D)Reduce the oscillatory amplitude.

Question 28

How is the radiographic assessment of neonatal lung volume performed?

A)Counting the number of anterior ribs above the diaphragm
B)Counting the number of posterior ribs above the diaphragm
C)Counting the number of posterior ribs below the clavicle
D)Counting the number of anterior ribs below the clavicle