Mechanical Ventilation Exam Questionnaire
Section 1: Initial Ventilator Configuration
1. What is the recommended tidal volume range for ALL adult patients requiring mechanical ventilation, regardless of underlying pathology?
- A) 8-10 ml/kg predicted body weight
- B) 10-12 ml/kg predicted body weight
- C) 4-8 ml/kg predicted body weight
- D) 2-4 ml/kg predicted body weight
Answer: C 1
2. Calculate the predicted body weight (PBW) for a male patient who is 180 cm tall:
- A) 75.2 kg
- B) 80 kg
- C) 85.1 kg
- D) 90 kg
Answer: A (PBW = 50 + 0.91 × (180 - 152.4) = 75.2 kg) 1
3. What is the absolute maximum plateau pressure that should NEVER be exceeded during mechanical ventilation?
- A) 35 cmH₂O
- B) 30 cmH₂O
- C) 25 cmH₂O
- D) 20 cmH₂O
Section 2: Driving Pressure and Lung Protection
4. What is the formula for calculating driving pressure?
- A) Peak pressure - PEEP
- B) Plateau pressure - Peak pressure
- C) Plateau pressure - PEEP
- D) Tidal volume / Compliance
Answer: C 2
5. What is the target driving pressure that should be maintained to reduce mortality risk?
- A) ≤10 cmH₂O
- B) ≤15 cmH₂O
- C) ≤20 cmH₂O
- D) ≤25 cmH₂O
Answer: B 2
6. Why is driving pressure considered superior to tidal volume or plateau pressure alone as a predictor of mortality?
- A) It is easier to measure
- B) It reflects the ratio of tidal volume to respiratory system compliance
- C) It requires less sedation to measure
- D) It is more stable over time
Answer: B 2
7. At what driving pressure level is there specifically increased risk of right ventricular failure in ARDS patients?
- A) ≥12 cmH₂O
- B) ≥15 cmH₂O
- C) ≥18 cmH₂O
- D) ≥20 cmH₂O
Answer: C 2
Section 3: ARDS-Specific Ventilation
8. What tidal volume range should be used for patients with ARDS?
- A) 6-8 ml/kg PBW
- B) 4-6 ml/kg PBW
- C) 8-10 ml/kg PBW
- D) 2-4 ml/kg PBW
Answer: B 1
9. For moderate to severe ARDS (PaO₂/FiO₂ <200), what PEEP strategy reduces mortality?
- A) Low PEEP (5-8 cmH₂O)
- B) Zero PEEP
- C) Higher PEEP strategies
- D) Variable PEEP based on compliance
Answer: C 2
10. What is the mortality reduction (adjusted RR) associated with higher PEEP strategies in moderate-severe ARDS?
- A) 0.95
- B) 0.90
- C) 0.85
- D) 0.80
Answer: B 2
11. What is the mortality reduction (RR) associated with prone positioning >12 hours/day in severe ARDS?
- A) 0.85
- B) 0.80
- C) 0.74
- D) 0.68
Answer: C 2
12. At what PaO₂/FiO₂ ratio should ECMO be considered for critically ill patients despite optimized ventilation?
- A) <150 mmHg
- B) <100 mmHg
- C) <80 mmHg
- D) <60 mmHg
Answer: B 1
Section 4: Asthma-Specific Ventilation
13. What respiratory rate should be set for mechanically ventilated asthmatic patients?
- A) 16-20 breaths/min
- B) 12-16 breaths/min
- C) 10-15 breaths/min
- D) 8-12 breaths/min
Answer: C 4
14. What I:E ratio should be used in asthmatic patients to prevent auto-PEEP?
- A) 1:2
- B) 1:3
- C) 1:4 or 1:5
- D) 1:1
Answer: C 4
15. What tidal volume range is recommended for asthmatic patients requiring mechanical ventilation?
- A) 4-6 ml/kg PBW
- B) 6-8 ml/kg PBW
- C) 8-10 ml/kg PBW
- D) 10-12 ml/kg PBW
Answer: B 4
16. What inspiratory flow rate should be set for adult asthmatic patients?
- A) 40-60 L/min
- B) 60-80 L/min
- C) 80-100 L/min
- D) 100-120 L/min
Answer: C 4
17. What size endotracheal tube should be used when intubating asthmatic patients?
- A) 6-7 mm
- B) 7-8 mm
- C) 8-9 mm
- D) 9-10 mm
Answer: C 4
18. What is the immediate intervention if severe hypotension develops in a mechanically ventilated asthmatic patient?
- A) Increase PEEP
- B) Administer fluid bolus
- C) Disconnect from ventilator to allow passive exhalation
- D) Increase respiratory rate
Answer: C 4
19. What is the minimum arterial pH that should be maintained when using permissive hypercapnia in asthmatic patients?
- A) 7.30
- B) 7.25
- C) 7.20
- D) 7.15
Answer: C 4
Section 5: Liberation from Mechanical Ventilation
20. For the initial spontaneous breathing trial (SBT) in patients ventilated >24 hours, what level of inspiratory pressure augmentation is recommended?
- A) 0 cmH₂O (T-piece)
- B) 3-5 cmH₂O
- C) 5-8 cmH₂O
- D) 8-10 cmH₂O
Answer: C 5
21. What is the strength of the recommendation for using inspiratory pressure augmentation during initial SBT?
- A) Strong recommendation
- B) Conditional recommendation
- C) No recommendation
- D) Strong recommendation against
Answer: B 5
22. For high-risk patients who have passed an SBT, what intervention is STRONGLY recommended immediately after extubation?
- A) High-flow nasal cannula
- B) Preventive noninvasive ventilation (NIV)
- C) Supplemental oxygen only
- D) No intervention needed
Answer: B 5
23. Which patient characteristics define "high risk for extubation failure"? (Select all that apply)
- A) Hypercapnia during SBT
- B) COPD
- C) Congestive heart failure
- D) Age >65 years
- E) Other serious comorbidities
Answer: A, B, C, E 5
24. What is the strength of recommendation for using protocols to minimize sedation in patients ventilated >24 hours?
- A) Strong recommendation
- B) Conditional recommendation
- C) No recommendation
- D) Strong recommendation against
Answer: B 5
25. What is the strength of recommendation for using ventilator liberation protocols in patients ventilated >24 hours?
- A) Strong recommendation
- B) Conditional recommendation
- C) No recommendation
- D) Strong recommendation against
Answer: B 5
26. For patients at high risk for postextubation stridor (PES) who meet extubation criteria, what test is suggested?
- A) Arterial blood gas
- B) Chest X-ray
- C) Cuff leak test
- D) Bronchoscopy
Answer: C 5
27. For adults who have failed a cuff leak test but are otherwise ready for extubation, what intervention is suggested?
- A) Delay extubation 24 hours
- B) Administer systemic steroids at least 4 hours before extubation
- C) Perform emergency tracheostomy
- D) Increase sedation and retry in 12 hours
Answer: B 5
28. What is the strength of recommendation for protocolized rehabilitation directed toward early mobilization in patients ventilated >24 hours?
- A) Strong recommendation
- B) Conditional recommendation
- C) No recommendation
- D) Strong recommendation against
Answer: B 5
Section 6: Monitoring and Assessment
29. Which parameters should be continuously monitored in ALL mechanically ventilated patients? (Select all that apply)
- A) Dynamic compliance
- B) Driving pressure
- C) Plateau pressure
- D) Patient-ventilator synchrony
- E) End-tidal CO₂
Answer: A, B, C, D 1
30. What is the strength of recommendation for assessing plateau pressure to ensure lung-protective ventilator settings?
- A) Strong recommendation, high certainty
- B) Conditional recommendation, moderate certainty
- C) Strong recommendation, low certainty
- D) Conditional recommendation, very low certainty
Answer: A 3
31. How should tidal volume be documented?
- A) In absolute milliliters only
- B) As mL/kg actual body weight
- C) As mL/kg predicted body weight
- D) As percentage of vital capacity
Answer: C 3
32. What device should be used to assess cuff pressure in artificial airways?
- A) Visual estimation
- B) Palpation method
- C) Manometer
- D) Stethoscope
Answer: C 3
33. Should continuous cuff pressure assessment be implemented to decrease the risk of ventilator-associated pneumonia?
- A) Yes, strong recommendation
- B) Yes, conditional recommendation
- C) No, strong recommendation against
- D) No, conditional recommendation against
Answer: C 3
Section 7: Clinical Scenarios
34. A 70 kg male patient (175 cm tall) with ARDS has a plateau pressure of 32 cmH₂O and PEEP of 12 cmH₂O. What is the FIRST action you should take?
- A) Increase PEEP to 15 cmH₂O
- B) Decrease tidal volume
- C) Increase respiratory rate
- D) Administer neuromuscular blockade
Answer: B (Plateau pressure exceeds 30 cmH₂O maximum) 1, 2
35. An asthmatic patient on mechanical ventilation suddenly develops severe hypotension. Blood pressure was 120/80 mmHg and drops to 70/40 mmHg. What should you do IMMEDIATELY?
- A) Start vasopressors
- B) Give 1L fluid bolus
- C) Disconnect from ventilator and press on chest wall
- D) Perform needle decompression
Answer: C 4
36. A patient with moderate ARDS (PaO₂/FiO₂ = 150) has the following settings: VT 400 mL (6 ml/kg PBW), PEEP 8 cmH₂O, Plateau pressure 28 cmH₂O. What is the driving pressure?
- A) 36 cmH₂O
- B) 28 cmH₂O
- C) 20 cmH₂O
- D) 8 cmH₂O
Answer: C (28 - 8 = 20 cmH₂O) 2
37. Based on the scenario in question 36, what action should be taken regarding the driving pressure?
- A) No change needed
- B) Decrease tidal volume
- C) Increase PEEP
- D) Both B and C
Answer: D (Driving pressure is 20 cmH₂O, exceeds target of ≤15 cmH₂O) 2
38. A patient has been mechanically ventilated for 48 hours and is ready for an SBT. What pressure support level should be used for the initial trial?
- A) 0 cmH₂O (T-piece)
- B) 5-8 cmH₂O
- C) 10-12 cmH₂O
- D) 15-20 cmH₂O
Answer: B 5
39. A COPD patient with hypercapnia passes an SBT after 72 hours of mechanical ventilation. What should be done immediately after extubation?
- A) Supplemental oxygen via nasal cannula
- B) High-flow nasal cannula
- C) Preventive noninvasive ventilation
- D) Room air observation
Answer: C (High-risk patient: COPD + hypercapnia) 5
40. A patient with severe ARDS has PaO₂/FiO₂ = 80 mmHg despite VT 4 ml/kg PBW, PEEP 18 cmH₂O, plateau pressure 29 cmH₂O, prone positioning for 16 hours/day, and neuromuscular blockade. What is the next step?
- A) Increase PEEP to 20 cmH₂O
- B) Decrease tidal volume to 3 ml/kg PBW
- C) Consider ECMO
- D) Increase FiO₂ to 1.0
Answer: C (PaO₂/FiO₂ <100 mmHg despite optimized ventilation) 1, 2