ACNP II Test I week 2 material (acute
respiratory) Questions & Answers
Assist/Control Ventilation Correct Ans-The volume delivered is controlled by the ventilator
for each breath. Pt can trigger the machine, but each breath has a SET tidal volume. ie: Rate 10,
TV 420 (at LEAST 10 BPM & which each breath-whether initiated by vent or pt-TV will be
420)
SIMV Correct Ans-for each mechanical breath the volume delivered is controlled, for each
non-vent breath the patient determines his or her own TV. Vent holds mechanical breath while pt
is exhaling. May add PS to assist with delivery of TV for the spontaneous breaths. May add
PEEP to recruit alveoli. ie: SIMV 8, TV 420, PS +5, PEEP 5.
Pressure Support Ventilation Correct Ans-May be a mode of ventilation ONLY for
spontaneous breathing, decreases the work of breathing by overcoming the resistance to
breathing (d/t lung pathology, weak respiratory muscles, ventilator tubing). Amount of gas
supplied is in proportion to the patient's inspiratory effort. *PS supports the patient's efforts.
Pressure control ventilation Correct Ans-(more of a laminar airflow), pressure is controlled,
TV is VARIABLE, must monitor TV hourly. ie: pressure 24 cm H20 (PIP), rate 10, PEEP 5. (10
BPM with variable TV to a max PIP, TV will vary by the lung compliance)
Pressure-regulated Volume Control (PRVC) Correct Ans-Pressure controlled ventilator with a
"target" TV. Vent controls the pressure delivered to achieve the goal TV (vent adjusts to varying
lung compliance). Adjust according to pt's plateau pressure of a given breath (increase in 3cm
H2o intervals)
, I:E inverse ratio ventilation Correct Ans-Provides 1:1 inspiratory time with goal of increasing
alveolar recruitment while decreasing peak airway pressures
HF ventilation (jet) Correct Ans-oscillates air 60-300 BPM
Mechanical ventilation with NO Correct Ans-pulmonary artery vasodilator; reduces PA
pressures & intrapulmonary shunting
Vent settings- FiO2 & PEEP initiation & weaning Correct Ans-FiO2: start @ .40-.70 & wean
down <.50; PEEP: start @ 5 & increases in 2-3 cm H20 intervals (allow time for recruitment of
alveoli).
Vent settings- TV initiation & weaning Correct Ans-New research-5-6 mL/kg (use ideal BW
in obese pts) with permissive hypercapnea (traditional was 10mL/kg)
Risks of high TV Correct Ans-high TV or high minute ventilation (>10L/min) can produce
detrimental alkalosis/barotrauma
Ventilator Complications Correct Ans-Barotrauma, decreased CO & Hypotension,
Volutrauma, Alkalosis, Pneumothorax,
Barotrauma Correct Ans-pressure trauma; can produce tension pneumothorax
respiratory) Questions & Answers
Assist/Control Ventilation Correct Ans-The volume delivered is controlled by the ventilator
for each breath. Pt can trigger the machine, but each breath has a SET tidal volume. ie: Rate 10,
TV 420 (at LEAST 10 BPM & which each breath-whether initiated by vent or pt-TV will be
420)
SIMV Correct Ans-for each mechanical breath the volume delivered is controlled, for each
non-vent breath the patient determines his or her own TV. Vent holds mechanical breath while pt
is exhaling. May add PS to assist with delivery of TV for the spontaneous breaths. May add
PEEP to recruit alveoli. ie: SIMV 8, TV 420, PS +5, PEEP 5.
Pressure Support Ventilation Correct Ans-May be a mode of ventilation ONLY for
spontaneous breathing, decreases the work of breathing by overcoming the resistance to
breathing (d/t lung pathology, weak respiratory muscles, ventilator tubing). Amount of gas
supplied is in proportion to the patient's inspiratory effort. *PS supports the patient's efforts.
Pressure control ventilation Correct Ans-(more of a laminar airflow), pressure is controlled,
TV is VARIABLE, must monitor TV hourly. ie: pressure 24 cm H20 (PIP), rate 10, PEEP 5. (10
BPM with variable TV to a max PIP, TV will vary by the lung compliance)
Pressure-regulated Volume Control (PRVC) Correct Ans-Pressure controlled ventilator with a
"target" TV. Vent controls the pressure delivered to achieve the goal TV (vent adjusts to varying
lung compliance). Adjust according to pt's plateau pressure of a given breath (increase in 3cm
H2o intervals)
, I:E inverse ratio ventilation Correct Ans-Provides 1:1 inspiratory time with goal of increasing
alveolar recruitment while decreasing peak airway pressures
HF ventilation (jet) Correct Ans-oscillates air 60-300 BPM
Mechanical ventilation with NO Correct Ans-pulmonary artery vasodilator; reduces PA
pressures & intrapulmonary shunting
Vent settings- FiO2 & PEEP initiation & weaning Correct Ans-FiO2: start @ .40-.70 & wean
down <.50; PEEP: start @ 5 & increases in 2-3 cm H20 intervals (allow time for recruitment of
alveoli).
Vent settings- TV initiation & weaning Correct Ans-New research-5-6 mL/kg (use ideal BW
in obese pts) with permissive hypercapnea (traditional was 10mL/kg)
Risks of high TV Correct Ans-high TV or high minute ventilation (>10L/min) can produce
detrimental alkalosis/barotrauma
Ventilator Complications Correct Ans-Barotrauma, decreased CO & Hypotension,
Volutrauma, Alkalosis, Pneumothorax,
Barotrauma Correct Ans-pressure trauma; can produce tension pneumothorax
