Deck 15: Noninvasive Mechanical Ventilation and Continuous Positive Pressure of the Neonate

Question 1

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

Answer 1

B
Infants with persistent apneic episodes who are unable to maintain PaCO₂ less than 60 mm Hg and pH greater than 7.25 should not be given CPAP. If they are already receiving CPAP, mechanical ventilation is indicated. Infants with congenital anomalies such as choanal atresia, cleft palate, tracheoesophageal fistula, or preoperative diaphragmatic hernia should not receive CPAP. CPAP is contraindicated in infants with neural muscular disorders, infants receiving CNS depressants, and infants with central apnea or frequent apneic episodes resulting in desaturation and/or bradycardia. In addition, severe cardiorespiratory instability and poor respiratory drive are also a contraindication to the initiation of CPAP.

Question 2

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

Answer 2

D
A high-pressure pop-off can be placed as close to the patient as possible should the expiratory limb become occluded.

Question 3

A bubble CPAP has been set up on an infant at 12 L/minute 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.

Answer 3

B
The pressure measured at the nasal prong could be slightly higher than the submersion depth of the expiratory tubing below the water surface when higher flow rates are used; therefore, airway pressure should always be monitored at the nasal prong to ensure proper CPAP levels.

Question 4

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 5

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

Question 6

Weaning strategies from CPAP include which of the following?
I) Decreasing CPAP to a predefined level of airway pressure and then stopping CPAP completely
II) Removing CPAP for a predetermined number of hours each day and gradually increasing the amount of time off CPAP each day until it can be stopped completely
III) Complete removal if vital signs stable
IV) Stopping CPAP and starting high-flow heated humidified air/oxygen via nasal cannula

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

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 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 9

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 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 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)

Question 12

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 13

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 14

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 to 10 L/minute
B) 11 to 15 L/minute
C) 16 to 20 L/minute
D) at least 15 L/minute

Question 15

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.

Question 16

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 17

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 18

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 19

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; PaCO₂ 50 mm Hg; 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 20

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.