Ventilation And Oxygenation

Question 1

GURD criteria

Answer 1

1 major and 4 minor

Major

• petechiae
• AMS
• hypoxaemia
• pulmonary oedema

Minor

• low grade temp, incr HR
• high ESR, low Hct, low plt
• fat in urine/sputum, retinal haemorrhage

Question 2

FES definition

Answer 2

Inflammatory response to embossed fat globules following surgery or trauma

Question 3

VAP bundle

Answer 3

HOB 30
Oral hygiene
Ulcer prophylaxis
DVT prophylaxis 
Daily Resp trial
Daily sedation trial

Question 4

VAP diagnosis

Answer 4

Patient stable/improving on vent for >48h, then

PEEP needs up 3+
FiO2 needs up 20%+
Purulent secretions +/- culture
T <36/>38
WCC <4/>12

Question 5

ARDS causes

Answer 5

Infective

• pneumonia
• sepsis
• septic shock

Non-infective

• aspiration
• transfusion
• polytrauma
• pancreatitis
• drug OD

Question 6

Lung protective ventilation - describe method

Answer 6

1. Initial TV 8ml/kg, reduce gradually to 6
2. RR to maintain baseline MV, not more than 35
3. Pplateau <30cmH2O
4. Minimum PEEP 5
5. Reduce TV by 1ml/kg q1-2h until 6ml/kg, can go to 4ml/kg if Pplat too high
6. Permissive hypercapnoea - maintain pH >7.2
7. Adjust PEEP and FiO2 to maintain sats 88-92