Which of the following patient conditions is least likely to experience hemodynamic changes with high alveolar pressures during mechanical ventilation?
a. ARDS
b. Emphysema
c. Kyphoscoliosis
d. Third-degree chest wall burns
ANS: A
Patients with stiff lungs (as in ARDS or pulmonary fibrosis) are less likely to experience hemo-dynamic changes with high pressures, because less of the alveolar pressure is transmitted to the intrapleural space. Patients with compliant lungs (as in emphysema) or with stiff, noncompliant chest walls (as in kyphoscoliosis and extensive chest wall burns) are more likely to have higher intrapleural pressures with PPV and experience more pronounced cardiovascular effects.
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