Question 1

With regard to mechanical ventilation, what ventilator settings are the

primary determinants of ventilation?
Fraction of inspired oxygen (FiO2) and tidal volume
FiO2 and positive end-expiratory pressure (PEEP)
Respiratory rate and tidal volume
Respiratory rate and PEEP
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Question 2
What are the primary determinants of peak inspiratory pressure (PIP)
for a ventilated patient?
Airway resistance and respiratory system compliance
Respiratory rate and tidal volume
Respiratory rate and respiratory system compliance
Airway resistance and tidal volume
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Question 3
What is the plateau pressure (Pplat)?
Pplat is the pressure in the respiratory system at end-exhalation,
measured with a expiratory pause.
 Pplat is the mediastinal pressure, measured as the central venous
pressure (CVP) minus PEEP.
Pplat is the average pressure in the airways, calculated over one
minute.
Pplat is the pressure at the end of inspiration, measured with an
inspiratory pause.
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Question 4
What is the difference between assist-control and pressure support?
With assist control, the patient cannot trigger the ventilator; with
pressure support, the patient triggers each breath.
With assist control, the patient always receives the same PEEP;
with pressure support, the patient can adjust the PEEP via their effort.
With assist control, the patient receives a set volume or pressure
with each breath; with pressure support, the patient can adjust the
volume they receive via their effort.
With assist control, the patient triggers each breath; with pressure
support, the patient cannot trigger the ventilator.
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Question 5
A patient with COVID-19 is transferred to the ICU from the floor with
worsening respiratory failure. What should be a guiding principle in
managing his ventilator settings?
Keep the FiO2 high to maximize his oxygenation.
Decrease the PEEP to minimize barotrauma to the alveoli.
Keep the plateau pressure less than 30 to minimize barotrauma to
the alveoli.
Keep the tidal volume high to prevent respiratory acidosis.
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Question 6
The patient described in question 5 has ventilator settings of AC/VC
525 mLs, PEEP of 5 cm H2O, rate of 22, and a FiO2 of 100%. His ABG
returns with pH of 7.35, PaCO2 41, PaO2 of 110. His PIP is 36 cm H2O,
and his Pplat is 33 cm H2O. His Auto-PEEP is 0. The following change
should be made to his ventilator settings:
Decrease his respiratory rate to decrease his PIP.
Decrease his TV to decrease his Pplat.
Turn down the PEEP because his oxygenation is adequate.
Increase his TV to assist in compensating for his metabolic
acidosis.
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Question 7
A patient is intubated for hypoxemic respiratory failure. Her vent is set
with assist control/volume control (AC/VC) with a tidal volume of 330
mLs, PEEP of 12 cm H2O, rate of 18, and a FiO2 of 100%. Her first ABG
returns as a pH of 7.14, a PaCO2 of 62, PaO2 of 120. The following
change should be made to her ventilator settings:
The PEEP should be increased to 15.
The tidal volume should be increased to 500.
The respiratory rate should be increased to 24.
Nothing; these values indicate permissive hypercapnia.
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Question 8
A patient with severe asthma is intubated for respiratory failure in the
ED. Her ventilator is set with a VC of 450 mLs, PEEP of 5 cm H2O, rate
of 22, and an FiO2 of 100%. Her PIP is 38 cm H2O, and her Pplat is 26
cm H2O. Her Auto-PEEP is 12. Her oxygen saturation is 100%. These
values tell you the following about her respiratory system:
Her respiratory system has high resistance.
Her respiratory system as poor compliance.
Her respiratory system has a large shunt.
Her respiratory system has a large amount of dead space.
Cannot be determined based on the information provided.
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Question 9
Regarding this patient above with asthma, what is the most important
change to make to her ventilator?
Decrease her tidal volume to prevent volutrauma.
Decrease the respiratory rate to allow time to exhale.
Increase her PEEP to open her airways.
Increase the inspiratory time to open her airways.
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Question 10
A patient with COVID-19 ARDS is set at AC/VC 380 mLs, PEEP of 8
cmH2O, rate of 26, and a FiO2 of 100%, with a Pplat of 22. Her ABG
returns with a pH of 7.30, PaCO2 of 50, PaO2 of 80. What would be an
appropriate maneuver?
Decrease PEEP to decrease her Pplat.
Perform a gentle, step-wise PEEP increase, monitoring the driving
pressure and compliance.
Prone the patient to improve her PaO2 to FiO2.
Increase the tidal volume to help recruit the lung.
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Question 11
A patient with severe ARDS is placed on the ventilator and set at a
best PEEP. Despite optimizing the ventilator settings and providing
deep sedation, the patient remains dyssynchronous with the
ventilator. The next best step is:
 Administer neuromuscular blockade to achieve ventilator
synchrony.
Change the patient to pressure support to allow the patient to
breathe desired tidal volumes.
Perform an SBT, as the patient clearly has sufficient respiratory
drive.
Keep the patient on current settings; as long as sedation is
provided, ventilator synchrony is not important.
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Question 12
During an initial spontaneous breathing trial (SBT), a patient who was
intubated for sepsis has a tidal volume of 250 mLs, a respiratory rate
of 32 breaths per minute. The next best course of action is:
Administer benzodiazepines to treat anxiety before extubating.
Defer extubation as the patient is not ready.
Increase the pressure support and re-perform the SBT.
Extubate, as the patient will feel less anxious without the
endotracheal tube in place.
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