What is permissive hypercapnia in the context of ARDS management?
Intentionally increasing CO2 levels to improve oxygenation
Allowing higher than normal CO2 levels to facilitate lung-protective ventilation
Using high PEEP to prevent alveolar collapse
Administering bicarbonate to correct respiratory acidosis
The Correct Answer is B
A. Intentionally increasing CO2 levels to improve oxygenation: The purpose of permissive hypercapnia is not to improve oxygenation directly but to prevent lung injury from high ventilatory pressures. Oxygenation is managed through other means such as PEEP and FiO2 adjustments rather than deliberately raising CO2.
B. Allowing higher than normal CO2 levels to facilitate lung-protective ventilation: In ARDS management, low tidal volumes are used to prevent barotrauma and volutrauma, which may result in elevated CO2 levels. This mild hypercapnia is accepted to prioritize lung protection, as long as the pH remains tolerable and the patient maintains adequate perfusion.
C. Using high PEEP to prevent alveolar collapse: While PEEP is used in ARDS to keep alveoli open and enhance oxygenation, it is a separate strategy from permissive hypercapnia. PEEP focuses on oxygenation, whereas permissive hypercapnia allows controlled CO2 retention to avoid ventilator-induced lung injury.
D. Administering bicarbonate to correct respiratory acidosis: Bicarbonate therapy is not routinely used in permissive hypercapnia, as mild acidosis is generally well tolerated. Treating the acidosis could counteract the protective ventilation strategy and lead to fluid or electrolyte imbalances.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Constipation: Constipation is a potential side effect of immobility or opioid use but is not directly related to mechanical ventilation or stiff lungs. It is a lower-priority concern in this context.
B. Unplanned extubation: While always a concern in ventilated patients, it is not specifically linked to the patient’s underlying pulmonary fibrosis or stiff lungs. Standard precautions can mitigate this risk.
C. Rapid respiratory rate: The ventilator controls respiratory rate in mechanically ventilated patients, and while tachypnea may occur with distress, it is less of a direct risk compared with complications from stiff lung tissue.
D. Barotrauma: Pulmonary fibrosis causes decreased lung compliance, meaning the lungs are stiff and less able to expand. Mechanical ventilation in stiff lungs increases the risk of barotrauma, such as pneumothorax, because the high pressures needed to ventilate noncompliant lungs can damage alveoli.
Correct Answer is B
Explanation
A. Increased sleepiness: While hypoxemia can eventually lead to fatigue or altered mental status, sleepiness is not the classic early sign of diffusion impairment in hypoxemic respiratory failure.
B. Hypoxemia is worse with activity, better with rest: Diffusion impairment limits oxygen transfer across the alveolar-capillary membrane. During activity, oxygen demand increases, and the impaired diffusion results in more pronounced hypoxemia. Rest decreases oxygen demand, allowing partial compensation.
C. Chest pain that occurs with activity and is better at rest: This is more characteristic of cardiac ischemia rather than diffusion impairment in the lungs.
D. Asymmetrical chest movement: Unequal chest movement suggests localized lung pathology, pneumothorax, or obstruction, not a global diffusion problem in hypoxemic respiratory failure.
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