Deck 16: Noninvasive Mechanical Ventilation of the Infant and Child

Question 1

A patient receiving bilevel ventilation develops a small leak at the interface. What action should the therapist take at this time?

A) The therapist should increase the pressure limit.
B) The therapist should increase the inspiratory flow.
C) The therapist should increase the length of the inspiratory time.
D) The therapist should verify that the ventilator automatically compensates for this leak.

Answer 1

D
Most bilevel ventilators available for commercial use are adept at delivering sufficient flow to reach the targeted level of inspiratory pressure. These devices also have a flow compensation feature that ensures that small leaks around the interface or through the mouth do not seriously impair performance. However, the capacity of NIV devices to compensate for severe leaks is limited, and the result is a greater patient/ventilation asynchrony, cited as a common reason for NIV failure in the acute setting.

Question 2

When considering NPAV devices, what is considered the most beneficial effect over NIV?

A) Its effect on CO₂ clearance
B) Its faster restoration of oxygenation
C) Its effect on cardiac filling pressures and volumes
D) Its effect on spontaneous tidal volume

Answer 2

C
The advantage of these devices is a beneficial effect on cardiac filling pressures and volumes, a benefit found even in healthy individuals.

Question 3

A patient receiving PAV is noticed to increase breathing effort. Which parameters will the ventilator modify to respond to this patient's increased respiratory demand?
I) Increase flow
II) Increase tidal volume
III) Increase pressure
IV) Increase CPAP

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

Answer 3

B
Unlike PSV, which uses a preset inspiratory pressure, PAV provides inspiratory flow and pressure in proportion to the patient's spontaneous breathing effort as determined by instantaneous feedback from an in-line pneumotachometer.

Question 4

What is the clinical significance of the IPAP-EPAP gradient in bilevel NIV?

A) It represents the mean airway pressure to which the patient's lungs are exposed.
B) It determines the patient's tidal volume.
C) The IPAP-EPAP gradient determines the inspiratory time.
D) This gradient determines the level of pressure support the patient will receive.

Question 5

What is considered the most successful therapeutic condition where NIV can be used in children?

A) Treatment of hypoxemic exacerbation of children with chronic neuromuscular disorders
B) Treatment of hypercapnic exacerbation of children with chronic neuromuscular disorders
C) Treatment of exacerbation of children with acute asthma attacks
D) Treatment of exacerbation of children with pulmonary edema due to congenital heart defects

Question 6

Which of the following NIV interfaces should the therapist consider when a child complains of discomfort with a nasal mask?
I) Oronasal mask
II) Nasal plugs
III) Helmet
IV) Nasal pillows

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

Question 7

What level of IPAP is typically sufficient to achieve the goals of NIV in pediatric patients?

A) 20 to 25 cm H₂O
B) 15 to 20 cm H₂O
C) 8 to 12 cm H₂O
D) 5 to 10 cm H₂O

Question 8

When should NIV be selected over CPAP in children with OSA?

A) For every patient who is hypoxemic
B) When OSA is complicated by alveolar hypoventilation and hypercarbia
C) When OSA is complicated by hypoxemia
D) For every patient who is hypoxemic and hypercapnic

Question 9

How should a volume-regulated ventilator for NIV be adjusted to deliver the appropriate tidal volume (VT) to a pediatric patient?

A) The preset VT should be equal to the patient's estimated anatomic dead space volume.
B) The delivered VT should be equal to the estimated anatomic dead space divided by the patient's respiratory rate.
C) The VT should be set by dividing the patient's PaCO₂ by two.
D) The delivered VT should be set at twice the child's physiologic VT.

Question 10

Which of the following restrictive disorders are likely to respond to both to NIV and CPAP in children?
I) Atelectasis
II) ARDS
III) Pneumonia
IV) Morbid obesity

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

Question 11

When a bilevel ventilator is used in the spontaneous/timed mode, at what point does the ventilator employ the timed feature?

A) During exhalation
B) To terminate inspiration
C) Throughout the ventilatory cycle
D) Only in the event of prolonged apnea

Question 12

HFNC has been ordered for a newborn at a rate of 2 L/minutes. What is the approximate nasopharyngeal pressure at this setting?

A) 3 cm H₂O
B) 2 cm H₂O
C) 1 cm H₂O
D) 1.5 cm H₂O

Question 13

What is the most effective way for the therapist to promote effective triggering and prevent asynchrony with NIV?

A) Optimize inspiratory flow.
B) Titrate inspiratory pressure to achieve a tidal volume of 5 mL/kg.
C) Set the device on spontaneous-timed mode.
D) Minimize leaks around the interface.

Question 14

In what particular setting has long-term use of NIV on children with cystic fibrosis been successful?

A) As a bridge to transplantation
B) As the routine treatment for bronchopulmonary hygiene
C) As the primary indication for reduction of exacerbations
D) As the primary treatment of hypoventilation

Question 15

When NIV is used to ventilate pediatric patients, which operating mode of ventilation is generally used?

A) Timed
B) Spontaneous
C) CPAP
D) Spontaneous/timed

Question 16

What is the most common complication associated with NIV among pediatric patients?

A) Ventilator-associated pneumonia
B) Gastric insufflation
C) Claustrophobia
D) Skin irritation caused by the interface

Question 17

Which of the following bilevel ventilator settings influences upper airway stability?

A) IPAP
B) Mode
C) Respiratory rate
D) EPAP

Question 18

What are the primary objectives of noninvasive ventilation (NIV)?
I) To increase the likelihood of successful weaning from mechanical ventilation
II) To improve respiratory gas exchange
III) To decrease the patient's work of breathing
IV) To reduce the risk of ventilator-associated pneumonia

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

Question 19

What effect should the therapist expect to observe after successful initiation of continuous positive airway pressure (CPAP) on a neonate who has a restrictive lung disorder?

A) Decreased arterial partial pressure of carbon dioxide (PaCO₂)
B) A lower mean airway pressure
C) A normal alveolar-arterial oxygen tension difference [P(A-a)O₂] gradient
D) Increased lung volume

Question 20

A child with a chronic disorder complicated by alveolar hypoventilation is placed on intermittent NIV at night. What is the primary goal of this therapy?

A) To decrease the work of breathing
B) To decrease the need for inserting an endotracheal tube
C) To improve the quality of sleep and reduce daytime symptoms
D) To improve arterial oxygenation

Question 21

What is the only absolute contraindication to a trial of NIV in pediatric patients with acute respiratory distress?

A) Cardiovascular instability
B) Nasopharyngeal obstruction
C) Inability to handle oral secretions
D) Extreme agitation or anxiety