Advanced | Pediatric Anesthesia Part I Flashcards by Hashim Abdullah

Which of the following is the primary physiologic response in a neonate exposed to a hypothermic environment?

(A) Hyperventilation

(B) Increased 2,3-DPG concentration in erythrocytes

(D) Shivering

(E) Vasoconstriction

C. Metabolism of brown fat (non shivering thermogenesis)

The newborn’s primary mechanism by which to compensate for heat loss is non-shivering thermogenesis.

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A 14-month-old child has tetralogy of Fallot with dynamic obstruction to right ventricular outflow. Which of the following is most likely to decrease cyanosis in this child?

A. Calcium
B. Epinephrine
C. Nitroglycerin
D. Nitroprusside
E. Propranolol

E. Propranolol

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After an uncomplicated cesarean delivery, a full-term neonate has intermittent cyanosis. Diaphragmatic effort is vigorous and respiratory distress is relieved while crying. The most likely diagnosis is:

A. Amniotic fluid aspiration
B. Choanal atresia
C. Diaphragmatic hernia
D. Tetralogy of Fallot

B. Choanal atresia

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Which of the following comorbidities is MOST strongly associated with an increased risk of central postoperative apnea in a preterm infant?

A. Gastroschisis
B. Anemia
C. Myelomeningocele
D. Omphalocele

B. Anemia

There is a high incidence of central postoperative apnea in former preterm infants who present for surgery. Apnea most commonly develops in patients younger than 46 weeks postconceptual age (PCA); however, apnea has been reported up to 60 weeks PCA.

Anemia (hematocrit <30%) is a potent, independent risk factor associated with apnea in former preterm infants. Routine, preoperative assessment for anemia should performed in former premature infants because the risk for apnea in anemic former preterm infants is not altered by postconceptual or gestational age.

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Which of the following DOES not exhibit a Right-to-Left Shunt?

A. Truncus Arteriosus
B. Tricuspid atresia
C. Tetralogy of Fallot
D. TAPVR
E. PDA

E. PDA

The 5 T’s of Right-to-Left Shunts

Truncus Arteriosus
Transposition
Tricuspid atresia
Tetralogy of Fallot
TAPVR

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Which of the following is NOT needed for a drug to cross the placenta?

A. Low molecular weight
B. High lipid solubility
C. Non-ionized form
D. Non-polar
E. Ionized form

E. Ionized form

For a drug/molecule to cross the PLACENTA, it has to be:

Non-Polar, Non-ionized, LOW molecular weight and HIGH lipid solubility

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Which of the following sets of data BEST represents an umbilical arterial blood gas analysis from a normal, healthy fetus immediately following delivery?

Data presented as: pH / PaCO2 (mm Hg) / PaO2 (mm Hg) / Bicarbonate (mEq/L) / Base excess (mEq/L).

A) 7.03 / 63 / 14 / 16 / –10
B) 7.24 / 52 / 22 / 23 / –3
C) 7.35 / 41 / 33 / 24 / –1
D) 7.41 / 39 / 98 / 25 / 0

B) 7.24 / 52 / 22 / 23 / –3

Umbilical cord blood gas analysis (or fetal scalp blood analysis) can be used to objectively assess a fetus’s or neonate’s condition before, during, or following delivery.

When measuring an umbilical cord blood sample, it is important to recall that the umbilical arteries are carrying blood away from the fetus and that a normal sample will appear “venous.” Similarly, a normal umbilical venous blood gas sample will appear “arterial,” as it is carrying maternal arterial blood to the fetus.

In fact, an umbilical venous blood gas sample can be used to assess the mother’s acid-base status.
The normal average values of an umbilical artery blood gas sample are approximately: pH 7.2-7.3, PaCO2 50-55 mm Hg, PaO2 18-25 mm Hg, bicarbonate 22-25 mEq/L, base excess –2.7 to –4.7 mEq/L.

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Which of the following statements regarding the anatomic and physiologic development of the newborn respiratory system is TRUE?

A) Lung compliance is reduced, but relative chest wall compliance is higher compared to adults

B) The neonatal diaphragm has a higher percentage of type I muscle fibers

C) The pulmonary system continues to grow and mature until approximately 12 months of age

A) Lung compliance is reduced, but relative chest wall compliance is higher compared to adults

The infant lung is less compliant compared to adults, while the chest wall is relatively more compliant.

The infant airway has several key anatomical differences compared to adults. Infants have a larger occiput; are obligate nose breathers despite having smaller nasal passages; and have relatively larger tongues, longer epiglottis, shorter trachea, and a more cephalad larynx (C3-4) compared to adults (C5-6).

These can lead to challenges in airway management. The physiology of the infant respiratory systems also differs from adults and has significant effects on anesthetic management.
Oxygen consumption is much higher in children.

It is estimated that, under general anesthesia, a healthy adult has a basal oxygen requirement of 2 to 4 mL/kg/min, while a healthy infant has an oxygen requirement of 6 to 9 mL/kg/min. To account for this increased demand, infants maintain significantly higher alveolar ventilation compared to adults.

This leads to more rapid
inhalational induction and anesthetic emergence. In addition, this results in a faster onset of hypoxia and hypercapnia during periods of inadequate ventilation. In addition, infants have immature hypoxic and hypercapnic respiratory drives that further contribute to the risk of hypoxemia. Tidal volumes in infants and children are comparable to adults in a volume-to-body weight ratio.

In an awake infant, functional residual capacity (FRC) is also similar to adults on a volume-to-body weight ratio; however, FRC is significantly reduced in an anesthetized infant, and this also contributes to the rapid onset of hypoxia.

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Compared with normal adults, which of the following characteristics of neonates best explains the more rapid inhalation induction in neonates?

(A) Greater cardiac index
(B) Greater metabolic rate
(C) Greater perfusion of vessel-rich tissues
(D) Greater ratio of alveolar ventilation to functional residual capacity
(E) Less lean body mass

(D) Greater ratio of alveolar ventilation to functional residual capacity

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During an inguinal hernia repair, a newborn infant will have a larger fluid requirement (in milliliters per kilogram) than an adult because of relatively greater

(A) insensible water loss
(B) lean body mass
(C) metabolic rate
(D) sodium loss
(E) third space losses

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(A) Assisted ventilation with a bag and face mask
(B) Insertion of a chest tube on the left side
(C) Insertion of a nasogastric tube
(D) Tracheal intubation and assisted ventilation
(E) Tracheal intubation and expansion of the left lung

(D) Tracheal intubation and assisted ventilation

Diagnosis: Congenital Diaphragm Hernia

The diagnosis of CDH can be made prenatally by fetal ultrasonography or fetal magnetic resonance imaging.

The infant has a scaphoid abdomen secondary to the absence of intra-abdominal contents, which have herniated into the chest. Breath sounds on the affected side are reduced or absent.

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Which of the following is NOT appropriate in terms of peri-operative management of CDH?

A. acidosis can precipitate pulmonary hypertension

B. permissive hypercapnia is instituted to reduce mortality

C. Left sided CDH has higher morbidity and mortality

D. For those with mild form and no respiratory distress, it may be beneficial to avoid intraoperative opioids and provide regional or neuraxial analgesia

C. Left sided CDH has higher morbidity and mortality

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Which of the following should be included in the preoperative management of a 12-year-old patient with Duchenne’s muscular dystrophy who is unable to ambulate?

(A) Determination of serum creatine kinase concentration
(B) Determination of serum potassium concentration
(C) Liver function profile
(D) Echocardiography
(E) Dantrolene prophylaxis

(D) Echocardiography

Cardiac evaluation is recommended every 2 years after diagnosis up until the age of 10.

Most patients with DMD die before their fourth
decade of life. Cardiac and respiratory complications are the most common causes of death.

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Compared with the adult airway, the neonatal airway has which of the following characteristics?

(A) More cephalad larynx
(B) Narrowest diameter at the vocal cords
(C) Relatively smaller epiglottis
(D) Smaller tongue relative to the size of the oral cavity
(E) Vocal cords perpendicular to the trachea

(A) More cephalad larynx

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An 8-kg, 5-month-old infant undergoes craniotomy for an arteriovenous malformation. During the procedure, severe hemorrhaging occurs and packed red blood cells 3 units are transfused rapidly. During infusion of the third unit, hypotension, nodal bigeminy, and prolongation of the QT interval are noted. The most appropriate management includes administration of:

(A) bicarbonate

(B) calcium

(D) lidocaine

(E) potassium

(B) calcium

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You are inducting a neonate who is scheduled for emergency surgical correction of imperforate anus. With regards to thermoregulation, which of the following is an effect of hypothermia in neonates?

(A) Decreased duration of neuromuscular blockade

(B) Increased narcotic requirements

(D) Metabolic alkalosis

(E) Shivering

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Which of the following should be included in the preoperative management of a 12-year-old patient with Duchenne muscular dystrophy who is unable to ambulate?

(A) Determination of serum creatine kinase concentration

(B) Determination of serum potassium concentration

(D) Echocardiography

(E) Dantrolene prophylaxis

(D) Echocardiography

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3 yr old child at PACU was recovering from a forearm surgery. Which of the following is the best way to validate pain assessment?

A. the reported severity from the child

B. the reported severity from the parent

C. the reported severity from the nursing staff

D. using the FLACC scale

E. the Wong-Baker Faces scale

D. using the FLACC scale

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In an infant, spinal anesthesia to a sensory level of T8 is achieved with tetracaine administered at the L2-3 interspace. Compared with spinal anesthesia to the same sensory level in an adult, this anesthetic is associated with a

(A) greater decrease in blood pressure

(B) higher risk for neurotoxicity

(D) lower risk for spinal cord injury

(E) shorter duration of action

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Compared with adults, neonatal respiratory function is characterized by:

(A) a lower ratio of dead space to tidal volume

(B) a more compliant chest wall

(D) less susceptibility to atelectasis

(E) the same oxygen requirement per kilogram of body weight

(B) a more compliant chest wall

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A 4-year-old child with myelomeningocele and a ventriculoperitoneal shunt is scheduled for bladder augmentation. One year ago, hypotension and bronchospasm occurred during laparotomy for placement of a feeding gastrostomy and responded to fluids and epinephrine. At that time, anesthesia was induced with thiopental, the trachea was intubated with a polyvinyl tracheal tube following administration of succinylcholine, and anesthesia was maintained with halothane and nitrous oxide. No diagnostic tests were performed after that incident. Which of the following should be avoided during the bladder augmentation?

(A) Latex gloves

(B) Polyvinyl tracheal tubes

(D) Succinylcholine

(E) Thiopental

(A) Latex gloves

spina bifida and latex allergy

The most important anesthetic consideration in Pierre Robin syndrome is

(A) anterior tilt of the larynx

(B) hyperplasia of the internal surface of the maxilla

(D) hypertrophy of the epiglottis

(E) tracheomalacia

During Harrington rod instrumentation for scoliosis, monitoring somatosensory evoked potentials

(A) is unreliable if halothane is used

(B) eliminates the need for a wake-up test

(D) accurately assesses motor function integrity

(E) is unreliable if nondepolarizing muscle relaxants are used

The most beneficial effect of continuous positive airway pressure in a newborn with respiratory distress syndrome is

(A) increased functional residual capacity

(B) decreased airway resistance

(D) increased alveolar PO2

(E) maintenance of functional closure of the foramen ovale

(A) increased functional residual capacity

Which of the following is NOT expected in a newborn? A. Newborn's hgb is 15 to 18 g/dL range higher than infant B. Blood glucose level of less than 45 mg/dL warrant therapy C. A glucose level between 80 and 100 mg/dL is expected in a full-term newborn D. The prothrombin time and partial thromboplastin time levels are about 10% longer in the newborn

C. A glucose level between 80 and 100 mg/dL is expected in a full-term newborn Glucose levels obtained close to the time of the proposed surgery are important in newborn. The stressed newborn, especially the stressed preterm or small for- gestational age newborn, are at particular risk for hypoglycemia. * A glucose level between 60 and 80 mg/dL is expected in a full-term newborn, with a preterm often 10 mg/dL below that.

You are anaesthetizing a pediatric patient who suffers from acute intermittent porphyria for abdominal surgery. You wish to administer antiemetic. Which of the following will most likely precipitate an acute attack of this disorder: A. Metoclopramide B. Prochlorperazine C. Phenylephrine D. Ondansetron E. Droperidol

A. Metoclopramide Bad drugs for Porphyria: ephedrine, ketamine, oxycodone, thiopentone, sevoflurane, metoclopramide, ropivacaine, hydralazine, nifedipine

Which of the following is the first line treatment for patients with congenital long QT syndrome: A. Pacemaker/defibrillator B. Accessory pathway ablation C. Beta blocker D. Calcium channel blocker

C. Beta blocker

A 35-kg child requires mechanical ventilation with pure oxygen at a tidal volume of 350 ml and a rate of 20/min during a severe asthma attack. The most likely cause of severe hypotension after initiating mechanical ventilation is: (A) hypoxic circulatory depression (B) inadequate expiratory time (C) increased pulmonary vascular resistance (D) respiratory alkalosis (E) tension pneumothorax

(B) inadequate expiratory time

How does our body respond to acute blood loss?

The body responds to acute blood loss with four basic compensatory mechanisms. The first response is increased cardiac output. Stroke volume increases due to decreased systemic vascular resistance (SVR). SVR decreases due to the diminished viscosity of the blood. As cardiac output increases, the distribution of blood flow changes. Blood flow is increased to vital organs, or organs that have higher oxygen extraction ratios. This (blood flow redistribution) is the primary mechanism for cardiac compensation to anemia. This is aided by an increase in oxygen extraction from hemoglobin. The heart itself has limited ability to increases its oxygen extraction, but compensates due to its increased coronary blood flow. The oxygen-hemoglobin dissociation curve adjusts during periods of anemia. Anemia causes an increase in 2,3-DPG, which shifts this curve to the right. This decreases the affinity of hemoglobin for oxygen, which facilitates oxygen extraction by tissues. During acute surgical blood loss, the adrenergic nervous system is stimulated, which leads to vasoconstriction and tachycardia.

Patient underwent laparotomy. It was unremarkable but the patient has been given 3L crystalloid with minimal EBL intraoperatively. The physiological response to such hemodilution includes ALL EXCEPT: a. Increased myocardial O2 extraction b. Increased tissue O2 extraction c. Increased tissue flow due to decrease viscosity d. Increased tissue flow due to vasodilatation

a. Increased myocardial O2 extraction While tissue can generally increase the extraction of oxygen from hemoglobin, myocardial tissue has limited ability to do so. The first response is increased cardiac output. Stroke volume increases due to decreased systemic vascular resistance (SVR). SVR decreases due to the diminished viscosity of the blood. As cardiac output increases, the distribution of blood flow changes. Blood flow is increased to vital organs, or organs that have higher oxygen extraction ratios. This (blood flow redistribution) is the primary mechanism for cardiac compensation to anemia. This is aided by an increase in oxygen extraction from hemoglobin. The heart itself has limited ability to increases its oxygen extraction, but compensates due to its increased coronary blood flow.

During prolonged labor, a fetal scalp blood sample shows a PO2 of 21 mmHg, a PCO2 of 46 mmHg, and a pH of 7.35. These findings suggest: (A) fetal hypoxemia (B) maternal hypoventilation (C) sampling of venous blood (D) miscalibration of the oxygen electrode (E) no abnormality

(E) no abnormality

Each of the following is a characteristic of prostaglandin E1 (alprostadil) pharmacology in an infant EXCEPT: (A) It is effective in the treatment of large left-to-right shunts (B) It is a cause of apnea (C) It is a potent vasodilator (D) It prevents closure of the ductus arteriosus (E) It is metabolized rapidly

(A) It is effective in the treatment of large left-to-right shunts

An 18-month-old child with tetralogy of Fallot is anesthetized with halothane and nitrous oxide. Following intubation, oxygen saturation decreases abruptly from 85% to 45%. The most effective treatment is: (A) discontinuation of halothane (B) hyperventilation (C) intravenous epinephrine (D) intravenous phenylephrine (E) positive end-expiratory pressure

(D) intravenous phenylephrine

During laser excision of vocal cord polyps in a 5-year-old boy, dark smoke suddenly appears in the surgical field. The trachea is intubated and anesthesia is being maintained with halothane, nitrous oxide, and oxygen. The most appropriate initial step is to: (A) change from oxygen and nitrous oxide to air (B) fill the oropharynx with water (C) instill water into the endotracheal tube (D) remove the endotracheal tube (E) ventilate with carbon dioxide

(D) remove the endotracheal tube

A delay in surgery for 24 to 48 hours for preoperative stabilization and preparation is acceptable in each of the following neonatal conditions EXCEPT (A) biliary atresia (B) diaphragmatic hernia (C) meningomyelocele (D) pyloric stenosis (E) tracheoesophageal fistula

(C) meningomyelocele * The infant with a myelomeningocele is usually operated on within the first 24 to 48 hours of life, thus reducing the risk for development of ventriculitis or progressive neurologic deficits. Complications of brainstem dysfunction in myelomeningocele includes stridor, apnea, bradycardia, aspiration pneumonia, sleep-disordered breathing patterns, vocal cord paralysis, lack of coordination, and spasticity. If the symptoms are not improved by shunting, posterior fossa decompression is necessary.

Which PE findings is NOT common and NOT suggestive of the presence of Congenital Diaphragmatic Hernia? A. Scaphoid abdomen B. Cyanosis C. Reduced breath sounds D. Nail clubbing

D. Nail clubbing

What are the 2 conditions of the diaphragm that may lead to CDH?

After closure of the pleuroperitoneal membrane, muscular development of the diaphragm occurs. Incomplete muscularization of the diaphragm results in the development of a hernia sac because of intra-abdominal pressure. The condition is known as eventration of the diaphragm, and the diaphragm may extend well up into the thoracic cavity. The other possibility is that the innervation of the diaphragm is incomplete and the muscle is atonic.

Which of the following is MOST ACCURATE regarding the pre-operative care of a patient with CDH? A. Immediate surgery for decompression and repair B. Induce respiratory alkalosis prior to the corrective surgery C. Allowing the PaCO2 to rise to 35 to 40 mmHg D. Goal of preductal arterial saturation above 85%

D. Goal of preductal arterial saturation above 85% The stabilization of an infant with CDH may require multiple treatment modalities. * The use of aggressive ventilation strategies to induce respiratory alkalosis has been abandoned secondary to the high incidence of iatrogenic lung injury. * Conventional ventilation with permissive hypercapnia is now favored. The goal is to maintain preductal arterial saturation above 85% using peak inspiratory pressures below 25 cm H2O and allowing the PaCO2 to rise to 45 to 55 mmHg

A 4 day old newborn

Because delayed surgical repair of CDH is now the norm, neonates with CDH frequently present to the operating room already intubated and on some form of ventilatory support. Despite a period of preoperative stabilization, some infants still have a component of reactive pulmonary hypertension. The goals of ventilatory management are to ensure adequate oxygenation and avoid barotrauma. * Any sudden deterioration in oxygen saturation with or without associated hypotension should raise suspicion of pneumothorax. It is important to avoid hypothermia because this increases the oxygen requirement and could precipitate pulmonary hypertension.

Which the following findings is most hazardous in premature infants? (A) Hematocrit of 55% (B) Rectal temperature of 35 degrees C (C) Umbilical arterial blood PO2 of 50 mmHg (D) Umbilical arterial blood PCO2 of 45 mmHg (E) Umbilical arterial systolic pressure of 60 mmHg

(B) Rectal temperature of 35 degrees C

A 1150-g, 10-day-old infant is undergoing a bowel resection for necrotizing enterocolitis. Heart rate is 200 bpm and blood pressure measured through a femoral artery catheter is 45/24 mmHg. The most appropriate next step is administration of (A) calcium gluconate (B) epinephrine (C) esmolol (D) fentanyl (E) normal saline solution

(E) normal saline solution These infants are among the most challenging cases in pediatric anesthesia. The fluid loss can be enormous, both because of surgical losses and third-space losses. Fluid management starts with full-strength, balanced salt solution for maintenance of blood pressure and urine output. Blood products are often needed during these cases. If the hematocrit is below 30% to 35%, red blood cells should be administered. Barash | 9th edit

Which of the following results in the greatest increase in right-to-left shunting in an infant with cyanotic heart disease? (A) Decreased pulmonary vascular resistance (B) Decreased systemic vascular resistance (C) Hemodilution (D) Increased heart rate (E) Myocardial depression

(B) Decreased systemic vascular resistance

You are anaesthetising a 6-month old infant for repair of a VSD. You perform an inhalational induction with 8% sevoflurane and 50% nitrous oxide. Several minutes later, whilst trying to secure IV access, the infant's oxygen saturations fall to 85%. The most appropriate next step in management. a) give fluid bolus b) change from sevoflurane to isoflurane c) apply CPAP d) reduce the FiO2 e) reduce sevoflurane

e) reduce sevoflurane Sevo improves SVR thus reversing shunt.

A full-term neonate has physical findings suggestive of congenital diaphragmatic hernia. Initial Apgar score is 2. Which of the following is the most appropriate initial management? (A) Placement of an orogastric tube (B) Insertion of a chest tube (C) Controlled ventilation by face mask (D) Controlled ventilation through an endotracheal tube (E) Spontaneous ventilation through an endotracheal tube

(D) Controlled ventilation through an endotracheal tube

The primary reason for the use of warmed humidified inspired anesthetic gases in children is to: (A) decrease postoperative respiratory complications (B) decrease postoperative shivering (C) preserve ciliary function (D) prevent dehydration (E) prevent evaporative heat loss

(E) prevent evaporative heat loss

Multimodal treatment of pulmonary hypertension is essential in the perioperative management of congenital diaphragmatic hernia. Which of the following regimens does not play a role in the treatment of pulmonary hypertension? A. Sildenafil B. Milrinone C. Imatinib D. Amiodarone E. Bosentan

D. Amiodarone Amiodarone can actually result to elevation of pulmonary pressure vasculature. Preoperative preparation may include multimodal treatment of pulmonary hypertension with nitric oxide, sildenafil (PDE-5 inhibitor), milrinone (PDE-3 inhibitor), epoprostenol or iloprost (PGI2 inhibitor), bosentan (endothelin inhibitor), and imatinib (platelet-derived growth factor inhibitor) which have all been attempted with varying degrees of success.

A full-term neonate has been admitted in the NICU for correction of congenital diaphragmatic hernia. For the past 48 hours, he had been manifesting symptoms suggestive of pulmonary hypertension. Avoidance of which of the following should be part of the peri-operative care? A. Nitrous oxide B. Rocuronium C. Remifentanil D. Etomidate D. Imatinib

A. Nitrous oxide

While at the pre-operative clinic, a pregnant mother told you about her concern regarding her previous child who presented with mental retardation, hypoglycemia, congenital heart disease, a large tongue, and an omphalocele. You would encourage this mother to undergo which of the following diagnostics to establish an antenatal diagnosis of abdominal wall defect? A. maternal serum α-fetoprotein (AFP) B. Beta-HCG C. maternal serum alpha-1 acid glycoprotein D. chorionic villus sampling

A. maternal serum α-fetoprotein (AFP) Screening for abdominal wall defects is accomplished through the use of maternal serum α-fetoprotein (AFP). AFP is a normal protein present in fetal tissues during fetal development. Closure of the abdominal wall and the neural tube (see “Myelomeningocele”) prevents release of large quantities of this protein into the amniotic fluid. High levels of AFP in the amniotic fluid can cross the placenta and be detected in maternal blood. Thus, abnormal levels of maternal serum AFP in the mother raise concerns over the possibility of either an abdominal wall defect or a neural tube defect in the fetus, as do high levels of AFP in fluid obtained during amniocentesis.

Which of the following is ACCURATE pertaining to the pathophysiology of neonatal abdominal wall defects? A. Gastroschisis results from interruption of the omphalomesenteric artery B. There is a high incidence of associated congenital anomalies with gastroschisis C. Neurodevelopmental outcomes are generally worse in gastroschisis D. Gastroschisis is highly associated with Beckwith– Wiedemann syndrome

A. Gastroschisis results from interruption of the omphalomesenteric artery * There is a high incidence of associated congenital anomalies with gastroschisis - False * Neurodevelopmental outcomes are generally worse in gastroschisis - FALSE * Gastroschisis is highly associated with Beckwith– Wiedemann syndrome - FALSE

A newborn is in respiratory distress. Examination shows a scaphoid abdomen, cyanosis while breathing oxygen by mask, and heart sounds in the right hemithorax. Which of the following is the most appropriate next step? (A) Assisted ventilation with a bag and face mask (B) Insertion of a chest tube on the left side (C) Insertion of a nasogastric tube (D) Tracheal intubation and assisted ventilation (E) Tracheal intubation and expansion of the left lung

(D) Tracheal intubation and assisted ventilation - to allow for permissive hypercapnia Lung protective ventilation strategy: Target SaO2 > 85% & permissive hypercapnia (PaCO2 <65 mmHg, pH >7.25) PCV or PSV PIP < 25 cmH2O Inspiratory time 0.35 s PEEP 3-5 mmHg RR < 65