Healthy areas of lung tissue in a patient with ARDS may be protected from lung injury caused by overdistention by which of the following?
a. Increasing FIO2
b. Decreasing PEEP
c. Using the prone position
d. Using a VT of 10-12 mL/kg
ANS: C
Placing a patient with ARDS in a prone position restricts chest wall movement, thereby prevent-ing severe transpulmonary pressure from causing alveolar stretch and edema, or shear stress. In-creasing the FIO2 may cause more atelectasis, which could worsen the situation. Decreasing PEEP would derecruit alveoli, shifting the volume to more compliant areas, which could increase the amount of lung injury. Using tidal volumes of 10-12 mL/kg would increase the risk of lung injury.
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