Which of the following methods enables the therapist to evaluate the presence of auto-PEEP? I. performing an inspiratory hold maneuver II. noting the presence of expiratory flow at the end of exhalation III. periodically measuring a smaller tidal volume during pressure-controlled ventilation IV. using an esophageal balloon
A. I, III only
B. II, IV only
C. I, III, IV only
D. II, III, IV only
ANS: B
A. Incorrect response: See explanation B.
B. Correct response: The presence of auto-PEEP can be evaluated via the following methods: (1) observing the persistence of expiratory flow at the end of the allotted expiratory time, which suggests incomplete lung emptying, and the presence of auto-PEEP, (2) observing from a flow-time scalar the failure of the expiratory flow to return to baseline and the initiation of an inspiration before expiratory flow ceases, (3) performing an end-expiratory hold following a mandatory breath devoid of any patient effort, and (4) using an esophageal balloon to detect the inspiratory triggering load imposed by any auto-PEEP. Esophageal pressure will be higher in the presence of auto-PEEP than in the absence of auto-PEEP.
C. Incorrect response: See explanation B.
D. Incorrect response: See explanation B.?
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