Exam 20: Weaning and Discontinuation from Mechanical Ventilation

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

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?

All of the following patients are intubated and receiving mechanical ventilation.Which of them is most likely to require slow liberation from mechanical ventilation?

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?

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 _____________________.

A female intubated patient has been weaned from full ventilatory support to PSV 5 cm H₂O,CPAP 5 cm H₂O,and an FɪO₂ of 0.3.The patient is alert and oriented and doing well.The respiratory therapist performs a cuff leak test.The average peritubular leak is 70 mL.The respiratory therapist should recommend which of the following?

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

A patient is extubated and placed on a cool,bland aerosol with 30% oxygen.Twenty minutes post extubation,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?

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.

Which of the following would suggest that a patient is ready to be weaned from a ventilator?

What ends inspiration in pressure support ventilation?

Calculate and determine the weanability of patients with this data: Cᴅ= 25 mL/cm H₂O,PImₐₓ = -28 cm H₂O,PₐO₂ = 93 mm Hg,PᴀO₂ = 158 mm Hg,and f = 22 breaths/min.

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 in the ICU who has successfully completed a 120-minute SBT requires extubation.Which of the following tests or values would indicate the potential for airway edema after extubation?

A 46-year-old male patient (IBW = 85 kg)who was injured in a motor vehicle crash has been receiving invasive mechanical ventilation for 24 hours.The patient is awake,alert,and looks comfortable on the following settings: VC-IMV with pressure support of 5 cm H₂O; set rate = 8 breaths/min; set Vᴛ = 500 mL; FɪO₂ = 0.4; PEEP = 5 cm H₂O.A 10-minute spontaneous breathing trial (SBT)yields this information: f = 30 breaths/min,RSBI = 145,P₀.₁ = 10 cm H₂O.What should the respiratory therapist suggest to the physician during patient rounds?

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?

When weaning is unsuccessful for a patient who successfully performs an SBT,which of the following factors should be assessed? 1)Cardiac factors 2)Nutritional status and respiratory muscle strength 3)Acid-base status 4)Psychological factors

How long does a tracheostomy site typically take to mature?

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.

A patient with amyotrophic lateral sclerosis has a tracheostomy tube in place.He has been unable to perform an SBT successfully and has been receiving mechanical ventilation for 4 months.An appropriate recommendation for this patient might be which of the following? 1)Transfer to a long-term care facility 2)Evaluation for the use of noninvasive ventilation (NIV) 3)Termination of ventilation 4)Waiting until the primary cause of respiratory failure has been resolved