WorksheetsMechanical Ventilation Questions
Total questions: 5
Worksheet time: 5mins
A 61-year-old man undergoes preoperative evaluation before coronary artery bypass surgery and aortic valve replacement surgery, both scheduled for tomorrow. He has been hospitalized in the cardiac intensive care unit (ICU) for 4 days after collapsing and experiencing cardiogenic shock. He was intubated in the field with a standard, nonsilver-coated endotracheal tube and placed on mechanical ventilation in the ICU. He is being treated with both paralytic and sedating medications, in addition to a proton pump inhibitor and intravenous nitroglycerin.
On physical examination, the patient's condition has stabilized and he is afebrile. No attempts are made to wean him from the ventilator because of his impending surgery and his heart condition.
Which of the following is the most appropriate measure to prevent ventilator-associated pneumonia in this patient?
Bathe patient daily in chlorhexidine
Begin preoperative antimicrobial prophylaxis immediately and continue until extubation
Maintain the head of bed above a 30-degree angle
Perform tracheotomy and remove endotracheal tube
Replace endotracheal tube with a silver-coated endotracheal tube
A 45-year-old woman is evaluated in the emergency department for the acute onset of dyspnea, wheezing, and progressive respiratory distress. She has a history of severe persistent asthma with two previous admissions to the intensive care unit, one of which required intubation. Her medications are a high-dose inhaled corticosteroid, salmeterol, and as-needed albuterol. She has not responded to aggressive bronchodilation therapy and intravenous corticosteroids.
On physical examination, she is in marked distress and is anxious. Temperature is 37.0°C (98.6°F), blood pressure is 145/ 100 mm Hg, pulse rate is 120/min, and respiration rate is 25/min; BMI is 35. Cardiac examination reveals a rapid and regular rhythm with no murmurs. Pulmonary examination reveals very faint wheezing.
Arterial blood gas studies breathing ambient air show a PCO2 of 80 mm Hg (10.6 kPa), a PO2 of 50 mm Hg (6.7 kPa), and a pH of 7.08. Chest radiograph shows hyperinflation but no infiltrates.
She undergoes rapid sequence induction and intubation and is started on mechanical ventilation.
Which of the following strategies in establishing ventilator settings is most appropriate for this patient?
Decreased inspiratory flow
Increased minute ventilation
Prolonged expiratory time
Prolonged inspiratory time
A 64-year-old woman is evaluated in the intensive care unit after receiving invasive mechanical ventilation for the past 6 days. She has acute respiratory distress syndrome, which was precipitated by multiple fractures sustained in a motor vehicle collision. Ventilator weaning trials are limited by tachypnea and hypoxemia. Her medications are fentanyl infusion, propofol infusion, subcutaneous heparin, and ranitidine.
On physical examination during full ventilator support, she is lightly sedated and in no respiratory distress. Temperature is 37.0°C (98.6°F), blood pressure is 148/77 mm Hg, pulse rate is 78/min, and respiration rate is 18/min. Weight is 92.0 kg (202.8 lb), up 6.0 kg (13.2 lb) since admission. Pulmonary examination is notable for decreased breath sounds at the bases. Cardiac examination reveals a regular rhythm with no gallop. There is trace edema of the extremities.
Laboratory studies reveal a normal creatinine level. Central venous pressure is 12 cm H2O. Oxygen saturation is 96% on an FIO2 of 0.45 and positive end-expiratory pressure of 5 cm H2O. Chest radiograph shows small bilateral pleural effusions but is otherwise unremarkable.
Which of the following interventions will most likely reduce the duration of this patient's mechanical ventilation?
Administer cisatracurium for 48 hours
Initiate scheduled doses of furosemide
Place the patient in the prone position
Treat with continuous inhaled nitric oxide
A 63-year-old man with acute respiratory distress syndrome (ARDS) is evaluated in the intensive care unit. He has just been intubated and placed on mechanical ventilation for ARDS secondary to aspiration pneumonia. Before intubation, his oxygen saturation was 78% breathing 100% oxygen with a nonrebreather mask.
On physical examination, temperature is 37.0°C (98.6°F), blood pressure is 150/90 mm Hg, and pulse rate is 108/min. His height is 150 cm (59 in) and his weight is 70.0 kg (154.3 lb). Ideal body weight is calculated to be 52.0 kg (114.6 lb). Central venous pressure is 8 cm H2O. Cardiac examination reveals normal heart sounds and no murmurs. Crackles are auscultated in the lower left lung field. The patient is sedated. Neurologic examination is nonfocal.
Mechanical ventilation is on the assist/control mode at a rate of 18/min. Positive end-expiratory pressure is 8 cm H2O, and FIO2 is 1.0.
Which of the following is the most appropriate tidal volume?
300 mL
450 mL
700 mL
840 mL
A 50-year-old man is evaluated in the intensive care unit for acute respiratory distress syndrome secondary to severe community-acquired pneumonia. He is intubated and placed on mechanical ventilation. He was previously healthy and took no medications before his hospitalization.
On physical examination, temperature is 38.3°C (100.9°F), blood pressure is 120/60 mm Hg, and pulse rate is 110/min. The patient weighs 60.0 kg (132.3 lb); ideal body weight is 60.0 kg (132.3 lb). He is sedated and is not using accessory muscles to breathe. Central venous pressure is 8 cm H2O. Other than tachycardia, cardiac examination is normal. There are bilateral inspiratory crackles.
Initial ventilator settings are volume control with a rate of 18/min, a tidal volume of 360 mL, positive end-expiratory pressure (PEEP) of 10 cm H2O, an FIO2 of 0.8, a peak pressure of 34 cm H2O, and a plateau pressure of 32 cm H2O. Oxygen saturation by pulse oximetry is 96%.
Which of the following is the most appropriate next step in management?
Decrease respiration rate
Decrease tidal volume
Increase FIO2
Increase PEEP
