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Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Pulmonary Disorders--->Mechanical Ventilation
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Question 11#Print Question

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


Question 12#Print Question

A 22-year-old woman with a history of asthma (previously intubated twice) presents to the emergency department with worsening dyspnea over the past week and is found to have influenza. Her chest radiograph demonstrates bilateral patchy opacities and she is intubated for hypoxemic respiratory failure and receives empiric antibiotics, bronchodilators, and steroids. Ventilator settings are:

  • pressure control-assist control with an inspiratory pressure (PInsp ) of 25 cm H2O
  • a PEEP of 5 cm H2O
  • a respiratory rate of 24 breaths per minute

On arrival to the ICU, she remains paralyzed after rapid sequence intubation, and on the above settings she is getting a TV of 200 mL (4 mL/kg IBW).

Which of the following statements is MOST accurate regarding her ventilator settings and physiology?

A. While she is paralyzed, her compliance can reliably be calculated from her inspiratory pressure and delivered volume
B. While she is paralyzed, you need to measure a pleural pressure to reliably calculate her pulmonary resistance
C. When her paralytics wear off, you would need to measure pleural pressure to reliably calculate her pulmonary compliance
D. Her pulmonary resistance is best assessed by looking at the difference between her peak inspiratory pressure and a pressure during an end-inspiratory pause


Question 13#Print Question

An 84-year-old man with severe chronic obstructive pulmonary disease (FEV1 20% predicted, on 4 L/min home O2 ) is admitted with severe hypoxemic respiratory failure due to a Streptococcus pneumoniae infection. He is intubated and placed on:

  • volume controlassist control ventilation with a set TV of 400 mL (6.5 mL/kg IBW)
  • PEEP of 8 cm H2O
  • a respiratory rate of 30 breaths per minute

When the paralytic used for intubation wears off, the patient is noted to be triggering additional spontaneous breaths with a total respiratory rate of 36 breaths per minute, and his exhaled TVs vary from 100 to 800 mL. During an end-expiratory pause, his airway pressure is 18 cm H2O.

Which of the following is the MOST accurate statement regarding his ventilator settings?

A. Because the patient is on volume control, he is receiving lungprotective TVs
B. The patient’s intrinsic PEEP is likely overestimated by the measured end-expiratory airway pressure
C. Changing the patient to pressure control will improve the patient’s intrinsic PEEP
D. The patient’s intrinsic PEEP is likely making it more difficult for him to trigger spontaneous breaths
E. Changing the patient to pressure control will provide more lung- protective TVs




Category: Critical Care Medicine-Pulmonary Disorders--->Mechanical Ventilation
Page: 3 of 3