Connects mechanical ventilator and selects initial setting – ARDS

FRCEM EXAM QuestionsCategory: December 2016Connects mechanical ventilator and selects initial setting – ARDS
FRCEM Intermediate Staff asked 10 months ago

A 25-year-old woman is brought into the ED with signs ofsevere sepsis. She was intubated and transferred to ITU. You arenow following up her progress a week later and you note she has
been diagnosed with ARDs.
A.Give two features of Lung protective ventilation strategy in ARDS? (1.5 marks)
B.What is the possible complication? (1.5 marks)

1 Answers
FRCEM Intermediate Staff answered 10 months ago

A.
set a Low tidal volume of 6mL/kg based on predicted body weight (PBW)
Low end-inspiratory plateau pressure
target plateau pressures  < 30 cmH20

Setting:
VT 6ml/Kg
RR 14
I:E 2:1
PEEP 10-15 cm H20

Watch pressure: may need to lower Vt, and accept higher CO2, titrate Fio2 and PEEP

Aim: Recruitment, Shunt reduction, Avoid atelectatic trauma, Achieve adequate oxygenation

B.
volutrauma (hyperinflation and shearing injury)
barotrauma (alveolar rupture and pneumothorax)
biotrauma (release of inflammatory mediators)
Atelectrauma (lung damage secondary to shear and strain of collapsible lung units opening and closing)