Midterm ACNP II- Questions & Answers
What is VILI? Correct Ans-It is Ventilator Induced Lung Injury
How does one get VILI? Correct Ans-Volutrauma- Overdistention d/t uneven distribution of
tidal volume in good/disease lung (AKA: Barotrauma)
Atelectrauma- Repetivie opening and closing of non-compliant alveoli shear/tears them d/t loss
of surfactant
Biotrauma- Systemic release of cytoxines, endotoxins (bacteria), loss of elasticity
What is the Tidal Volume in ARDS treatment? Correct Ans-6-8ml/kg of PREDICTED BODY
WIEGHT
What is the lung protective strategy with low Tidal volume in ARDS? Correct Ans-Low TV
ventilation
-Vt 6ml/kg of PBW
-Keep PPlat <30cm H20
-Increase PEEEP to 10-15cm H20
What are the oxygen goals in lung protective strategy with low Tv? Correct Ans-FiO2 < 0.6
PaO2 > 60
, SaO2 ) 88%
We allow for permissive hypercapnia (adjust RR to increase MV while maintaining low TV)-
PaCO2 >45 and pH >7.25
What strategy do we use in ARDS to increase lung recrutiment? Correct Ans-Prone position-
improves oxygenation
When is proning contraindicated? Correct Ans-Increased ICP
Severe hemoptysis
Recent sternal surgery
Pregnancy
New DVT
Unstable fractures
What are recruitment maneuvers? Correct Ans-Temporary maneuvers to recruit alveoli (think
temporary hyperinflation)
When are recruitment maneuvers used cautiously? Correct Ans-Hypovolemia or shock
What does APRV do? Correct Ans-Airway Pressure Release Ventilation
-Long inspiratory time at elevated pressure
-Short expiratory tim at low pressure (not 0cm H20)
What is VILI? Correct Ans-It is Ventilator Induced Lung Injury
How does one get VILI? Correct Ans-Volutrauma- Overdistention d/t uneven distribution of
tidal volume in good/disease lung (AKA: Barotrauma)
Atelectrauma- Repetivie opening and closing of non-compliant alveoli shear/tears them d/t loss
of surfactant
Biotrauma- Systemic release of cytoxines, endotoxins (bacteria), loss of elasticity
What is the Tidal Volume in ARDS treatment? Correct Ans-6-8ml/kg of PREDICTED BODY
WIEGHT
What is the lung protective strategy with low Tidal volume in ARDS? Correct Ans-Low TV
ventilation
-Vt 6ml/kg of PBW
-Keep PPlat <30cm H20
-Increase PEEEP to 10-15cm H20
What are the oxygen goals in lung protective strategy with low Tv? Correct Ans-FiO2 < 0.6
PaO2 > 60
, SaO2 ) 88%
We allow for permissive hypercapnia (adjust RR to increase MV while maintaining low TV)-
PaCO2 >45 and pH >7.25
What strategy do we use in ARDS to increase lung recrutiment? Correct Ans-Prone position-
improves oxygenation
When is proning contraindicated? Correct Ans-Increased ICP
Severe hemoptysis
Recent sternal surgery
Pregnancy
New DVT
Unstable fractures
What are recruitment maneuvers? Correct Ans-Temporary maneuvers to recruit alveoli (think
temporary hyperinflation)
When are recruitment maneuvers used cautiously? Correct Ans-Hypovolemia or shock
What does APRV do? Correct Ans-Airway Pressure Release Ventilation
-Long inspiratory time at elevated pressure
-Short expiratory tim at low pressure (not 0cm H20)
