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Journal of Neuroscience Nursing:
doi: 10.1097/JNN.0000000000000057
CE Test: Online Only

Complex Care: Ventilation Management When Brain Injury and Acute Lung Injury Coexist

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PURPOSE: The purpose of this learning activity is to provide information about the management of coexisting brain injury and acute lung injury/acute respiratory distress syndrome (ALI/ARDS).

OBJECTIVES: After reading this article and taking this test, the reader will be able to:

1. Describe contemporary management of brain and lung injury.

2. State the pathophysiology behind brain and lung injury.

3. Identify research related ventilator strategies for coexisting brain and acute lung injuries.

1. The most conflicting parameter goal with ALI/ARDS and brain injury is control of

a. carbon dioxide.

b. blood pressure.

c. pH.

d. PaO2.

2. Temporary hyperventilation in a patient with brain injury has which level of evidence?

a. I

b. II

c. IIA

d. III

3. Which tidal volume is recommended for ALI/ARDS management?

a. 4 ml/kg

b. 6 ml/kg

c. 8 ml/kg

d. 10 ml/kg

4. Which of the following plateau pressures is recommended for ALI/ARDS management?

a. <30 cm H2O

b. <35 cm H2O

c. <40 cm H2O

d. <45 cm H2O

5. To maintain optimal oxygenation in a brain-injured patient lacking autoregulation, management of which parameter is of primary importance?

a. mean arterial pressure

b. O2 saturation

c. cerebral perfusion pressure

d. intracranial pressure (ICP)

6. Extracranial causes of intracranial hypertension include

a. posture.

b. trauma.

c. hydrocephalus.

d. brain tumor.

7. Hypercarbia leads to cerebral

a. dehydration.

b. alkalosis.

c. vasodilation.

d. artery occlusion.

8. Which criterion differentiates ARDS from ALI?

a. PAWP ≤ 18 mm Hg

b. PaO2/FiO2 ratio ≤ 200 mm Hg

c. bilateral infiltrates

d. left arterial hypertension

9. Which of the following would most likely decrease mortality in patients with ALI/ARDS if maintained?

a. tidal volume 10 ml/kg

b. PaO2 98%

c. positive end expiratory pressure (PEEP) 15 mm Hg

d. peak pressure 30 cm H2O

10. Since 1988, mortality associated with ALI/ARDS after traumatic brain injury is

a. unchanged.

b. lower.

c. significantly lower.

d. higher.

11. PEEP should be

a. lower than ICP.

b. equal to ICP.

c. higher than ICP.

d. set independently of ICP.

12. Which of the following is more of a concern with tracheal gas insufflation as compared to other ventilation strategies?

a. hypercapnea

b. renal injury

c. increased auto-peep

d. blood pressure changes

13. Which of the following is more of a concern with high frequency oscillatory ventilation (HFOV) as compared to other ventilation strategies?

a. hypercapnea

b. renal injury

c. increased auto-peep

d. blood pressure changes

14. Which of the following is more of a concern with use of nitric oxide as compared to other ventilation strategies?

a. increased expiratory flow

b. renal injury

c. blood clot formation

d. overdistended alveoli

15. An adverse effect of prostacyclin infusion is

a. platelet aggregation.

b. pulmonary hypertension.

c. hypotension.

d. neuronal cell death.

16. Prostacyclin use has demonstrated

a. increased brain tissue O2.

b. decreased ICP.

c. increased cerebral perfusion pressure.

d. vasoconstriction.

17. Which of the following is not required during extracorporeal membrane oxygenation (ECMO)?

a. patient heparinization

b. 1:1 or 1:2 registered nurse to patient ratio

c. major vessel cannulation

d. hypercapnia

18. Research on baboons demonstrated that a PaCO2 of 50 mm Hg caused the major cerebral arteries to

a. dilate.

b. constrict.

c. spasm.

d. rupture.

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