Critical Care Medicine-Neurologic Disorders>>>>>Other Parenchymal Disease and pulmonary edema
Question 5#

A 5-year-old female patient has fallen from the balcony of her apartment located on a third floor. Impact on various branches of a tree before hitting the soil has dampened the velocity of the impact. Trauma burden includes two broken ribs on the right hemithorax, lung contusion, and a suspicion of spinal cord injury at the level of T1. She has to be sedated for a magnetic resonance imaging session.

Which strategy could BETTER diminish the incidence of postprocedure atelectasis?

a. Intubation, sedation with sevoflurane, PEEP of 5 cm H2O, a tidal volume of 10 mL/kg, and a FiO2 of 1.0
b. Spontaneous breathing, sedation with propofol, and 15 L/min of oxygen on a non-rebreathing O2 mask
c. Noninvasive ventilation, sedation with midazolam, and a FiO2 of 1.0
d. Any strategy with the lowest possible FiO2

Correct Answer is D


Correct Answer: D

Breathing an unnecessarily high FiO2 leads to alveolar collapse (hyperoxic atelectasis) and, in addition, increases alveolar permeability, decreases surfactant production, and induces inflammatory mediators (thereby ventilation-induced lung injury). There is not an easy predictable PEEP value that protects all patients from atelectasis, although any value has been shown to be more protective than a PEEP of 0 cm H2O. It has been shown that patients who are sedated and spontaneously breathing without invasive ventilation or PEEP have a lower risk for atelectasis when compared to those who were sedated and mechanically ventilated. Available physiological evidence suggests that breathing a lower FiO2 was protective against atelectasis. 


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