NPS Mechanical Ventilation Exam
Questions and Answers
Which ventilator mode provides two levels of CPAP and permits spontaneous breathing
at both levels:
A. pressure control ventilation
B. high frequency oscillation
C. Neurally adjusted ventilation
D. airway pressure release ventilation - ANSWER-D. APRV
Following suctioning in patients with ARDS, which of the following would re-expand
collapsed lung units?
A. inspiratory pause
B. sigh maneuver
C. decreased inspiratory flow
D. expiratory retard maneuver - ANSWER-B. sigh maneuver - a type of alveolar
recruitment maneuver
Normal PIP settings - ANSWER-Full term with normal lungs = 20-25 cmH2O
Infants with IRDS may require higher = 25-30 cmH2O
Normal rate settings - ANSWER-Low birth weight infant = 30-40
Term infant = 20-30
Children = 12-20
Normal I times - ANSWER-Infants = 0.25-0.5
Children = 0.5-0.7
Higher rates require Lower I time for sufficient E time
Normal PEEP - ANSWER-3-8 cmH2O 8 = max PEEP for newborn
Adjusting Ventilator sequence according to Kettering - ANSWER-1. adjust PIP to
achieve adequate ventilation - maintain tidal volume.
2. adjust Rate to maintain desired PaCO2
- use higher rates with lower PIP with pulmonary disorders to avoid barotrauma
- use lower rate and higher PIP to improve oxygenation, higher Paw
3. adjust I time
, - longer I time to improve oxygenation
- shorter I time to increase E time and reduce air-trapping/overinflation
Reverse I:E ratio - ANSWER-Improves gas distribution, oxygenation and maintains
inspiratory pressure.
Used for patients with decreased compliance and PaO2, requiring high FiO2 and PEEP
when to increase FiO2 vs. PEEP - ANSWER-increase Fi)2 to 60, then begin to increase
PEEP
PEEP - increases FRC, decreases intrapulmonary shunting, recruit collapsed alveoli
and increased oxygenation
Excessive PEEP may be caused by: - ANSWER-excessive flow or malfunctioning
PEEP valve
Step for weaning according to Kettering - ANSWER-1. decrease PIP in increments of 1-
2 to reach 25 cmH2O
2.decrease rate in increments of 3-5 to rate of 10-12 - adjust I time accordingly
3. decrease FiO2 in increments of 2-5% to 0.40
4. decrease PEEP by increments of 1 to 5 or less
Normal Tidal Volumes - ANSWER-Infants 4-8 mL/kg
Children 6-19 mL/kg
CMV / AC indications - ANSWER-patients with increased ICP/traumatic brain injury -
PaCO2 of 25-30 for first 24 hours
flail chest
dys-synchrony with vent - should be controlled using sedation also
for elevated PaCO2 - first thing to do according to Kettering! -
ANSWER-remove/decrease any mechanical deadspace!
then you can increase tidal volume or rate to compensate
Dynamic compliance - ANSWER-Vt / PIP-PEEP
Static compliance - ANSWER-Vt / Plateau-PEEP
Increasing airway Resistance, causes and treatments - ANSWER-PIP increases, while
Plateau remains the same
Secretions - suction
Questions and Answers
Which ventilator mode provides two levels of CPAP and permits spontaneous breathing
at both levels:
A. pressure control ventilation
B. high frequency oscillation
C. Neurally adjusted ventilation
D. airway pressure release ventilation - ANSWER-D. APRV
Following suctioning in patients with ARDS, which of the following would re-expand
collapsed lung units?
A. inspiratory pause
B. sigh maneuver
C. decreased inspiratory flow
D. expiratory retard maneuver - ANSWER-B. sigh maneuver - a type of alveolar
recruitment maneuver
Normal PIP settings - ANSWER-Full term with normal lungs = 20-25 cmH2O
Infants with IRDS may require higher = 25-30 cmH2O
Normal rate settings - ANSWER-Low birth weight infant = 30-40
Term infant = 20-30
Children = 12-20
Normal I times - ANSWER-Infants = 0.25-0.5
Children = 0.5-0.7
Higher rates require Lower I time for sufficient E time
Normal PEEP - ANSWER-3-8 cmH2O 8 = max PEEP for newborn
Adjusting Ventilator sequence according to Kettering - ANSWER-1. adjust PIP to
achieve adequate ventilation - maintain tidal volume.
2. adjust Rate to maintain desired PaCO2
- use higher rates with lower PIP with pulmonary disorders to avoid barotrauma
- use lower rate and higher PIP to improve oxygenation, higher Paw
3. adjust I time
, - longer I time to improve oxygenation
- shorter I time to increase E time and reduce air-trapping/overinflation
Reverse I:E ratio - ANSWER-Improves gas distribution, oxygenation and maintains
inspiratory pressure.
Used for patients with decreased compliance and PaO2, requiring high FiO2 and PEEP
when to increase FiO2 vs. PEEP - ANSWER-increase Fi)2 to 60, then begin to increase
PEEP
PEEP - increases FRC, decreases intrapulmonary shunting, recruit collapsed alveoli
and increased oxygenation
Excessive PEEP may be caused by: - ANSWER-excessive flow or malfunctioning
PEEP valve
Step for weaning according to Kettering - ANSWER-1. decrease PIP in increments of 1-
2 to reach 25 cmH2O
2.decrease rate in increments of 3-5 to rate of 10-12 - adjust I time accordingly
3. decrease FiO2 in increments of 2-5% to 0.40
4. decrease PEEP by increments of 1 to 5 or less
Normal Tidal Volumes - ANSWER-Infants 4-8 mL/kg
Children 6-19 mL/kg
CMV / AC indications - ANSWER-patients with increased ICP/traumatic brain injury -
PaCO2 of 25-30 for first 24 hours
flail chest
dys-synchrony with vent - should be controlled using sedation also
for elevated PaCO2 - first thing to do according to Kettering! -
ANSWER-remove/decrease any mechanical deadspace!
then you can increase tidal volume or rate to compensate
Dynamic compliance - ANSWER-Vt / PIP-PEEP
Static compliance - ANSWER-Vt / Plateau-PEEP
Increasing airway Resistance, causes and treatments - ANSWER-PIP increases, while
Plateau remains the same
Secretions - suction
