ARF

Question 1

Type 1 ARF

Answer 1

Acute Hypoxemic Respiratory Failure

Question 2

This type of respiratory failure occurs with alveolar flooding and subsequent ventilation-perfusion mismatch and intrapulmonary shunt physiology.

Answer 2

Type 1

Question 3

Avoiding lung injury (volutrauma) through low tidal volume (____)

Answer 3

6 mL/kg of ideal body weight

Question 4

Type____ respiratory failure occurs in clinical settings such as sepsis, gastric aspiration, pneumonia, COVID-19 (Chap. 199), near-drowning, multiple blood transfusions, and pancreatitis.

Answer 4

I

Question 5

_____has been shown to improve survival in those with severe ARDS

Answer 5

Prone positioning

Question 6

In addition, a “____” management strategy ( taining a low central venous pressure [CVP] or pulmonary capillary wedge pressure [PCWP]) is associated with fewer days of mechanical ventilation than a “fluid-liberal” strategy (maintaining a relatively high CVP or PCWP) in ARDS in those patients who have been resuscitated from shock

Answer 6

fluid-conservative

Question 7

____ from repeated alveolar stretching/overdistention.

Answer 7

Volutrauma

Question 8

This type of respiratory failure is a consequence of alveolar hypoventilation and results from the inability to eliminate carbon dioxide effectively.

Answer 8

Type II

Question 9

Type II Respiratory Failure

Answer 9

Hypercapneic Respiratory Failure

Question 10

The mainstays of therapy for hypercapnic respiratory failure are directed at ____

Answer 10

reversing the underlying cause(s) of ventilatory failure.

Question 11

This form of respiratory failure results from lung atelectasis.

Answer 11

Type 3 Lung Atelectasis

Question 12

Type 3 Lung Atelectasis also called ___

Answer 12

Perioperative Respiratory Failure

Question 13

After general anesthesia, decreases in functional residual capacity lead to collapse of dependent lung units. Such atelectasis can be treated by _____

Answer 13

frequent changes in position

chest physiotherapy

upright positioning

and control of incisional and/or abdominal pain.

Question 14

This form most often results from hypoperfusion of respiratory muscles in patients in shock.

Answer 14

Type IV Metabolic Demands

Question 15

Which of the following best describes the pathophysiology of Type I respiratory failure?
A) Hypercapnia due to alveolar hypoventilation
B) Reduced cardiac output causing decreased tissue perfusion
C) Alveolar flooding leading to ventilation-perfusion mismatch and shunt physiology
D) Hypoperfusion of respiratory muscles due to shock

Answer 15

C

Question 16

Which of the following is a common clinical setting associated with Type I respiratory failure?
A) Myasthenia gravis
B) Brainstem injury
C) Sepsis
D) Drug overdose

Answer 16

C

Question 16

Which of the following is a cornerstone of management for ARDS in Type I respiratory failure?
A) High tidal volume ventilation
B) Prone positioning
C) Neuromuscular blockade in all patients
D) Fluid-liberal strategy

Answer 16

B

Question 17

What is the primary concern with mechanical ventilation in ARDS patients?
A) Hypercapnia due to impaired ventilation
B) Alveolar overdistention causing volutrauma
C) Increased risk of spontaneous pneumothorax
D) Development of pleural effusion

Answer 17

B

Question 18

Type II respiratory failure is primarily caused by:
A) Increased dead-space ventilation
B) Alveolar hypoventilation
C) Ventilation-perfusion mismatch
D) Decreased lung compliance

Answer 18

B

Question 19

Which of the following conditions is least likely to cause Type II respiratory failure?
A) Guillain-Barré syndrome
B) Pulmonary embolism
C) Drug overdose
D) Myasthenia gravis

Answer 19

B

Question 20

Which of the following best explains the development of Type III respiratory failure?
A) Hypoperfusion of respiratory muscles
B) Alveolar flooding due to pulmonary edema
C) Lung collapse due to decreased functional residual capacity
D) Increased dead-space fraction from pulmonary embolism

Answer 20

C

Question 21

Which intervention is least appropriate for managing Type III respiratory failure?
A) Frequent position changes
B) Upright positioning
C) Fluid-liberal strategy
D) Chest physiotherapy

Answer 21

C

Question 22

Type III respiratory failure is commonly referred to as:
A) Ventilator-induced lung injury
B) Perioperative respiratory failure
C) Cardiogenic shock-induced failure
D) Acute pulmonary embolism failure

Answer 22

B

Question 23

Which condition commonly associated with Type IV respiratory failure results from lactic acidosis?
A) Hypoperfusion of the lungs
B) Muscle fatigue
C) Respiratory arrest
D) Myasthenia gravis

Answer 23

A

Question 24

____ are the mainstay of therapy for analgesia in mechanically ventilated patients.

Answer 24

Opiates

Question 25

_____sedatives are preferred because benzodiazepines are associated with increased delirium and worse patient outcomes.

Answer 25

Nonbenzodiazepine

Question 26

Amnesia can be achieved reliably with ___ and _____ such as lorazepam and midazolam.

Answer 26

propofol

benzodiazepines

Question 27

Accordingly, all intubated, mechanically ventilated patients should undergo _____I

Answer 27

daily screening of respiratory function.

Question 28

The patient has passed the screening test and should undergo a spontaneous breathing trial (SBT).

Answer 28

> oxgenation is stable (i.e., Pao 2 /FIo 2 [partial pressure of oxygen/fraction of inspired oxygen] >200 and PEEP ≤5 cmH 2 O)
cough and airway reflexes are intact
No vasopressor agents or sedatives are being administered

Question 29

The SAT/SBT trial consists of a period of breathing through the endotracheal tube without ventilator support (continuous positive airway pressure [CPAP] of ___ cmH O with or without low-level pressure support and an open T-piece breathing system have all been validated) for 30–120 min.

Answer 29

5

Question 30

The spontaneous breathing trial is declared a failure and stopped if any of the following occur: _____

Answer 30

(1) respiratory rate >35/min for >5 min

(2) O 2 saturation <90%

(3) heart rate >140/min or a 20% increase or decrease from baseline

(4) systolic blood pressure <90 mmHg or >180 mmHg,

(5) increased anxiety or diaphoresis.