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Exam 20: Discontinuation and Weaning From Mechanical Ventilation

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Question 1

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A patient who requires prolonged ventilatory support should not be considered permanently ventilator dependent until ________ month(s) has/have passed and all weaning attempts during that time have failed.

A) 1
B) 3
C) 6
D) 9

E) All of the above
F) A) and B)

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Question 2

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The mode of ventilation that maintains a minimum V_E by increasing or decreasing the amount of support (V_T or respiratory rate) given to the patient is ___________________.

A) volume support
B) automatic tube compensation
C) mandatory minute ventilation
D) adaptive support ventilation

E) None of the above
F) B) and C)

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Question 3

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Which mode of ventilation delivers the exact amount of pressure required to overcome the resistive load imposed by the ET tube for the flow measured at the time?

If a patient who has failed an SBT still meets the criteria for discontinuation of ventilation,an SBT should be performed every _______ hours to determine weanability.

At what pressure is pressure support not high enough to contribute significantly to ventilatory support but is sufficient to overcome the work imposed by the ventilator system?

Sixty minutes after a patient is extubated,an arterial blood gas sample is drawn;the results are: pH = 7.20,PaCO₂ = 60 mm Hg,PaO₂ = 55 mm Hg,SaO₂ = 80%,HCO₃^- = 23 mEq/L with a 2 L/min nasal cannula.The patient is SOB and complaining of chest pain.His blood pressure is 92/50 mm Hg.The most likely cause of this weaning failure is which of the following?

Which parameter is used as the primary index of the drive to breathe?

A recently extubated patient develops a partial upper airway obstruction,which causes stridor.What action can the respiratory therapist take to improve the patient's condition?

How long does a tracheostomy site typically take to mature?

A postoperative patient,still under anesthesia,is being ventilated with VC-CMV with Automode.After 2 hours the patient is waking up and beginning to breathe spontaneously.The ventilator will respond by _____________________.

In which patient would continued use of an artificial airway be necessary?

A 46-year-old male patient (IBW = 85 kg) who was injured in a motor vehicle accident has been receiving invasive mechanical ventilation for 24 hours.The patient is awake and alert and looks comfortable on these settings: VC-SIMV with pressure support of 5 cm H₂O;set rate = 8 breaths/min;set V_T = 500 mL;F_IO₂ = 0.4;PEEP = 5 cm H₂O.A 10-minute spontaneous breathing trial (SBT) yields this information: f = 30 breaths/min,RSBI = 145,P_0.1 = 10 cm H₂O.What should the respiratory therapist suggest to the physician during patient rounds?

A patient being actively weaned from mechanical ventilation currently is receiving the following ventilatory support: pressure support = 15 cm H₂O,spontaneous V_T = 575 mL,spontaneous rate = 14 breaths/min,spontaneous V_T = 500 mL,F_IO₂ = 35%,PEEP = 5 cm H₂O.The arterial blood gas results are: pH = 7.42,PaCO₂ = 38 mm Hg,PaO₂ = 94 mm Hg,SaO₂ = 98%,HCO₃^- = 24 mEq/L.What should the respiratory therapist do next?

Assess the following data obtained from the spontaneous breathing trials of four patients.Which patient is most likely to be weaned successfully at this time?

An SBT should not continue for longer than _____ minutes.

A patient is extubated and placed on a cool,bland aerosol with 30% oxygen.Twenty minutes postextubation,the respiratory therapist is called to assess the patient,who has shortness of breath.The respiratory therapist observes intercostal retractions,accessory muscle use,and a respiratory rate of 38 breaths/min.Stridor can be heard without a stethoscope,and the SpO₂ has dropped from 97% to 85%.The patient is given an aerosolized racemic epinephrine treatment and reassessed.Accessory muscle use continues,intercostal retractions decrease slightly,and stridor is heard on auscultation.The patient's respiratory rate is 30 breaths/min,and the SpO₂ is 88%.What should the respiratory therapist recommend?

What ends inspiration in pressure support ventilation?

The ACCP/SCCM/AARC task force recommends that a search for all possible causes that may be contributing to ventilator dependence be undertaken in patients who require mechanical ventilation for longer than ______ hours.

A patient is being weaned from invasive mechanical ventilation using VC-SIMV without pressure support.The respiratory therapist reviews the following data from the last few hours. What should the respiratory therapist recommend for this patient?

The closed loop mode used for weaning from mechanical ventilation is which of the following?