Critical Care Medicine-Neurologic Disorders>>>>>Mechanical Ventilation
Question 11#

A 56-year-old woman with a history of recently diagnosed acute myeloid leukemia is admitted to the ICU after undergoing induction chemotherapy. She is febrile with temperature of 39°C and has a respiratory rate of 36 breaths per minute with SaO2 84% on 10L per minute oxygen by face mask. Her labs are otherwise notable for an absolute neutrophil count of 125.

Which of the following is the most accurate statement regarding her management?

A. Use on noninvasive ventilation instead of invasive ventilation is associated with increased mortality
B. Airway pressure release ventilation (APRV) is the preferred lung protective ventilator mode
C. Sedation with benzodiazepines is associated with longer ICU length of stay
D. Diuresis to a goal body balance of about even over the first 7 days is associated with decreased mortality

Correct Answer is C


Correct Answer: C

Immunocompromised patients with ARDS are a unique population with both different epidemiology of infections and different data for management. Specifically, in patients with single-organ failure, the use of noninvasive ventilation has been associated with improved mortality compared with invasive ventilation (answer A is incorrect). Although APRV can increase mean airway pressure and therefore can improve oxygenation, there is no benefit to APRV compared with standard volume control-assist control ventilation and depending on the settings may not represent a volume-controlled mode (ie may be more injurious) (answer B is incorrect). Although diuresis to a goal body balance even over 7 days is associated with more ventilator-free days, it is not associated with decreased mortality (answer D is incorrect). Sedation with benzodiazepines, as compared with sedation with propofol or dexmedetomidine, is associated with longer length of stay and duration of mechanical ventilation (answer C is correct). Some studies also suggest an association between benzodiazepines and worse cognitive outcomes as well as increased short-term mortality. Sedation with nonbenzodiazepinecontaining regimens is therefore preferred.


  1. Hilbert G, Gurson D, Vargas F, et al. Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. N Engl J Med. 2001;344(7):481-487.
  2. ARDS Clinical Trials Network. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006;354:2564-2575.
  3. Fraser GL, Devlin JW, Worby CP, et al. Benzodiazepine versus nonbenzodiazepine-based sedation for mechanically ventilated, critically ill aduts: a systematic review and meta-analysis of randomized trials. Crit Care Med. 2013;41:S30-S38.