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RES 240 Week 3 Physiology of Ventilatory Support

In which of the following types of ventilation is alveolar expansion during inspiration due to an increase in alveolar pressure?

II. Positive-pressure ventilation

During volume-controlled continuous mandatory ventilation, should either compliance decrease or airway resistance (Raw) increase, what will happen?

The peak airway pressure will increase.

What patients are at greatest risk for auto?positive end-expiratory pressure (PEEP)?

II. Those with high airway resistance. III. Those with high expiratory flow resistance.

Pressure-controlled (PC) modes of ventilatory support include all of the following except:

volume-controlled continuous mandatory ventilation.

Moderate rises in pleural pressure during positive-pressure ventilation have a minimal effect on cardiac output in normal subjects. What are some reasons for this lack of effect?

II. Compensatory increase in venomotor tone III. Compensatory increase in the cardiac rate

On what does volume delivered depend during pressure-targeted modes of ventilatory support?

I. Set pressure limit II. Patient lung mechanics III. Patient effort

For patients with respiratory insufficiency, pressure-supported ventilation (PSV) has all of the following advantages over spontaneous breathing except:

Increased muscle activity

Positive-pressure ventilation (PPV) can reduce urinary output by how much?

30% to 50%

Which of the following statements are TRUE about negative-pressure ventilation (NPV)?

I. NPV is similar to spontaneous breathing. II. Airway (mouth) pressure during NPV is zero. III. Expiration during NPV is by passive recoil. IV.NPV decreases pressure at the body surface.

Which of the following variables determine the level of support achieved with adaptive support ventilation?

I. Patient effort III. Resistance of the endotracheal tube

Inspection of the airway pressure waveform of a patient receiving volume-controlled continuous mandatory ventilation assist-control with constant flow reveals a large dip or drop in pressure at the beginning of inspiration. Which of the following problems is most likely?

The trigger setting is improper.

Which of the following parameters are set when volume-supported ventilation (VSV) is used?

I. Tidal volume II. Maximum peak pressure III. Positive end-expiratory pressure (PEEP) IV. Flow

The magnitude of WOBpt depends on which of the following?

I. Compliance II. Resistance III. Ventilatory drive IV. Trigger sensitivity V. Peak flow

Hyperventilation should generally be avoided during mechanical ventilatory support. Exceptions to this rule include:

II. failure of other methods to reduce intracranial pressure.

Which of the following is considered a normal spontaneous tidal volume?

5 to 7 ml/kg

Which of the following is the best explanation for the decreased levels of atrial natriuretic hormone commonly observed among patients receiving positive-pressure ventilation?

Decreased right atrial transmural pressure

A patient receiving long-term positive-pressure ventilation support exhibits a progressive weight gain and a reduction in the hematocrit. W hich of the following is the most likely cause of this problem?

Water retention

Which of the following is the recommended tidal volume for mechanical ventilation in acute respiratory failure?

4 to 8 ml/kg

Which level of plateau pressure increases the likelihood of causing lung injury?

> 30 cm H2O

Which of the following variables determine the level of support achieved with proportional assist ventilation?

I. Patient effort II. Elastance III. Resistance

Which of the following is a benefit of high inspiratory flows during positive-pressure ventilation?

Reduced air trapping

Which of the following variables determine the level of support achieved with adaptive support ventilation?

I. Patient effort III. Time constant

Which of the following modes of ventilatory support is used to help decrease airway and alveolar pressures?

Pressure-controlled continuous mandatory ventilation

The volume of gas actually delivered to a patient by most positive-pressure ventilation is always less than that expelled from the machine. Which of the following factors help to explain this finding?

I. Gas compression under pressure III. Expansion of the ventilator circuitry

Which of the following mechanisms explains the hepatic dysfunction in patients receiving positive-pressure ventilation (PPV)?

Decreased hepatic blood flow

Types of damage associated with pulmonary barotrauma include all of the following except:

pneumoconiosis.

Which of the following is the explanation for the increased V/Q ratio when excessive positive end-expiratory pressure (PEEP) is used?

Diversion of blood from ventilated alveoli to hypoventilated alveoli

Detrimental effects of positive end-expiratory pressure (PEEP) include all of the following except:

increased CL.

Which of the following are considered safe settings for a recruitment maneuver?

I. Pressures up to 50 cm H2O IV. Pressures applied for 1 to 3 minutes

Which of the following groups of patients are primarily affected by ventilator-associated pneumonia?

I. Infants II. Adults older than 65 years III. Immunosuppressed IV. Thoracoabdominal surgery V. Depressed sensorium

During volume-assured pressure-supported ventilation, the breath will be pressure-limited under what conditions?

The delivered tidal volume (VT) is greater than the preset minimum VT.

When bedside work of breathing measures are unavailable, you should adjust the level of pressure-supported ventilation (PSV) to which of the following breathing patterns?

Spontaneous Rate 15 to 25/min VT 5 to 8ml/kg

Which of the following modes of ventilatory support would result in the highest mean airway pressure?

Volume-controlled continuous mandatory ventilation

Which of the following statements is false about positive-pressure ventilation (PPV)?

During inspiration, pleural pressure decreases.

In which of the following types of ventilation is alveolar expansion during inspiration due to a decrease in pleural pressure?

II. Negative-pressure ventilation (NPV) III. Spontaneous ventilation

Which of the following terms describe the lung injury associated with the use of low tidal volumes?

Atelectrauma

Contraindications for using positive end-expiratory pressure (PEEP) in conjunction with mechanical ventilation include which of the following?

I. Untreated bronchopleural fistula III. Untreated pneumothorax

Which of the following conditions is associated with a lack of response to increased FIO2 in patients receiving positive-pressure ventilation?

Shunt

All of the following factors would tend to increase mean airway pressure except:

short inspiratory times.

Mean airway pressure may be increased by all of the following adjustments, except increasing the:

FIO2.

What spontaneous pressure-controlled breath mode allows separate regulation of the inspiratory and expiratory pressures?

Bilevel positive airway pressure (BiPAP)

A patient switched from pressure-controlled continuous mandatory ventilation (CMV) with positive end-expiratory pressure (PEEP) to pressure-controlled inverse ratio ventilation (PC-IRV) shows a good improvement in PaO2 but a decrease in tissue oxygenation. Which of the following best explains this observation?

High mean pressures caused by PC-IRV decreased cardiac output.

The increased work of breathing associated with auto?positive end-expiratory pressure (PEEP) during mechanical ventilation is due to:

I. hyperinflation or impaired contractility of the diaphragm. II. large alveolar pressure drops required to trigger breaths.

Ventricular dysfunction occurs in patients receiving positive-pressure ventilation for all of the following reasons except:

hypervolemia.

Assuming a constant rate of breathing, which of the following inspiratory/expiratory ratios (I:E) would tend to most greatly impair a patient's systemic diastolic pressure?

1:1

In which of the following modes of ventilatory support would the patient's work of breathing be least?

Continuous mandatory ventilation (CMV)

Which of the following is the consequence of decreased resistance and compliance?

It takes less time to fill and empty the alveoli.

Which of the following conditions does not require high mechanical respiratory rates?

Metabolic alkalosis

Which of the following is FALSE about continuous positive airway pressure (CPAP)?

It provides the pressure gradient needed for ventilation.

Volume-controlled (VC) modes of mechanical ventilation include which of the following?

I. VC continuous mandatory ventilation II. VC intermittent mandatory

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