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Take PAB's SmartPrep Sample Question
A 32-year-old woman presents in the emergency department with acute onset tachypnea and shortness of breath after suffering a chest contusion due to a vehicular collision. Chest x-ray reveals bilateral infiltrates. After intubation, all of the following parameters can be set on the ventilator EXCEPT:
(A) P-high 30 cmH2O
(B) P-high 20 cmH2O
(C) P-low 5 cmH2O
(D) P-low 10 cmH2O

Did you get it right?
Answer Explanation
A is incorrect. This is a case of acute lung injury which is managed with airway pressure release ventilation (APRV). An APRV P-high setting of 30 cm H2O is within the acceptable range of 15-30 cmH2O.
B is incorrect. This is a case of acute lung injury which is managed with airway pressure release ventilation (APRV). An APRV P-high setting of 20 cm H2O is within the acceptable range of 15-30 cmH2O.
C is incorrect. This is a case of acute lung injury which is managed with airway pressure release ventilation (APRV). An APRV P-low setting of 5 cm H2O is within the acceptable range of 0-5 cmH2O.
D is correct. This is a case of acute lung injury which is managed with airway pressure release ventilation (APRV). An APRV P-low setting of 10 cm H2O is not within the acceptable range of 0-5 cmH2O.
Bottom Line Explanation:
Airway pressure release ventilation (APRV), is also referred to as Bi-level Positive Airway Pressure (BiPAP) or pressure-control ventilation with pressure support (PCV+), depending on the manufacturer. It is a form of pressure-controlled, time-cycled mode of ventilation that provides two different levels of CPAP (P-high and P-low) with an inverse I:E ratio and allows spontaneous breathing at both levels of CPAP. An APRV P-high should be between 15-30 cm H20 and P-low between 0-5 cm H2O.
References:
Hess D, Kacmarek, R. Advanced Modes of Mechanical Ventilation In: Essential of Mechanical Ventilation. 4 ed. McGraw-Hill. 2019, page 73-86

