Review Question - QID 209969

This patient is presenting with pancreatitis which has led to acute respiratory distress syndrome (ARDS). Optimal care involves placing the patient on a ventilator and setting it to high PEEP, low tidal volume, and high CO2 levels (permissive hypercapnea).

ARDS typically presents with respiratory distress in critically ill patients. It can occur secondary to events such as trauma, sepsis, drug overdose, transfusion, pancreatitis, or aspiration. Symptoms can be non-specific and typically include desaturation in a critically ill patient. The underlying condition must be treated and the patient should be put on the ventilator with settings that reflect a high PEEP (keeps alveoli open), low tidal volume (to protect from over inflation), and permissive hypercapnea (to reduce oxygen toxicity).

Figure A is a chest radiograph demonstrating diffuse and bilateral infiltrates suggestive of acute respiratory distress syndrome. Chest radiography can reflect symmetric or asymmetric lesions in particular when imposed on a preexisting pulmonary process.

Incorrect Answers:
Answer 1: 100% oxygen by nasal cannula would be an insufficient intervention for a case of ARDS.

Answer 2: Bilevel positive airway pressure (BiPAP) can be an appropriate intervention to avoid intubation in patients who can maintain their airway. It could be appropriate in cases of asthma or COPD.

Answer 3: Ventilation with high PEEP, high tidal volume, and high CO2 levels has a high tidal volume which could cause damage via over inflation.

Answer 5: Ventilation with high PEEP, low tidal volume, and low CO2 levels has low CO2 levels which fails to deliver permissive hypercapnia to protect against oxygen toxicity.

Bullet Summary:
The appropriate ventilator setting in acute respiratory distress syndrome is high PEEP, low tidal volume, and high CO2 levels.