FFICM Respiratory Management and Mechanical Ventilation 2

Question 1

Which combination of criteria most appropriately indicates readiness to perform a spontaneous breathing trial (SBT)?

Accepted Answer

FiO2 ≤0.4, PEEP ≤5–8 cmH2O, hemodynamic stability without high-dose vasopressors

Answer

SBT readiness requires adequate oxygenation on low FiO2/PEEP, hemodynamic stability, and the ability to initiate spontaneous breaths.

Question 2

What is the dominant mechanism by which ventilator-associated pneumonia (VAP) develops in ICU patients?

Accepted Answer

Microaspiration of colonised oropharyngeal secretions past the endotracheal tube cuff

Answer

VAP most commonly results from microaspiration of bacteria-laden oropharyngeal secretions that pool above the cuff and leak into the lower airways.

Question 3

A Rapid Shallow Breathing Index (RSBI) greater than 105 breaths/min/L during an SBT predicts:

Accepted Answer

High likelihood of spontaneous breathing trial failure

Answer

An RSBI >105 indicates rapid, shallow breathing consistent with respiratory muscle fatigue, predicting SBT failure with high sensitivity.

Question 4

Ventilator-Induced Diaphragm Dysfunction (VIDD) is best described as:

Accepted Answer

Diaphragmatic atrophy and contractile weakness caused by controlled mechanical ventilation

Answer

VIDD develops rapidly (within hours) when controlled ventilation eliminates diaphragm contractions, leading to disuse atrophy and oxidative injury.

Question 5

Which single intervention has the strongest evidence for reducing ventilator-associated events (VAE) in ICU patients?

Accepted Answer

Maintaining the head of bed at 30–45 degrees to reduce aspiration

Answer

Semi-recumbent positioning at 30–45° is supported by randomised evidence to reduce aspiration and is a core component of ventilator care bundles.

(FFICM) Final Faculty of Intensive Care Medicine Practice Test