The therapist is using gas exchange criteria to establish PEEP for a mechanically ventilated patient with ARDS. Therefore, which of the following approaches would be used to determine the appropriate PEEP level? I. the lower inflection point II. PEEP-Fio2 table III. Pao2/Fio2 IV. PEEP titration curve
A. I, II only
B. II, IV only
C. I, II, IV only
D. II, II, IV only
ANS: B
A. Incorrect response: See explanation B.
B. Correct response: The two current approaches to using gas exchange criteria to set PEEP are (1) the PEEP titration curve, which generally follows a volume recruitment maneuver. Step changes in PEEP are then used to determine the lowest Fio2 that can be achieved for the desired Pao2 goal. (2) The PEEP-Fio2 table is an empirical approach that attempts to balance a Sao2 goal with the harmful effects of pressure and Fio2. These tables describe step changes in both PEEP and Fio2 to maintain a target Pao2 (Spo2). Refer to Table 15-2 on page 292 of the text.
C. Incorrect response: See explanation B.
D. Incorrect response: See explanation B
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