FFICM Respiratory Management and Mechanical Ventilation 3

Question 1

According to the Berlin Definition, which PaO2/FiO2 ratio (with PEEP ≥5 cmH2O) classifies ARDS as severe?

Accepted Answer

<100 mmHg

Answer

<200 mmHg

Answer

<300 mmHg

Answer

<150 mmHg

Question 2

Current evidence-based guidelines recommend prone positioning in severe ARDS for a minimum duration of:

Accepted Answer

At least 12–16 hours per session

Answer

2–4 hours per session

Answer

Only while PaO2/FiO2 remains below 300 mmHg

Answer

Continuously without time limit until oxygenation normalises

Question 3

Non-invasive positive pressure ventilation (NIV) is most strongly indicated in COPD exacerbation when:

Accepted Answer

The patient has hypercapnic respiratory failure with arterial pH 7.25–7.35

Answer

Arterial pH is below 7.25 with haemodynamic instability

Answer

The patient cannot protect their airway due to obtundation

Answer

Chest X-ray shows diffuse bilateral infiltrates suggesting pneumonia

Question 4

Compared with conventional oxygen therapy, high-flow nasal oxygen (HFNO) most notably differs by:

Accepted Answer

Delivering heated humidified gas at up to 60 L/min, generating modest nasopharyngeal CPAP and reducing anatomical dead space

Answer

Delivering 100% FiO2 via a tightly sealed non-rebreather mask at 15 L/min

Answer

Requiring procedural sedation for patient tolerance due to discomfort

Answer

Being restricted to post-operative patients following thoracic surgery

Question 5

In a patient with severe status asthmaticus requiring mechanical ventilation, the preferred ventilation strategy is:

Accepted Answer

Permissive hypercapnia with low respiratory rates to allow adequate expiratory time and prevent air trapping

Answer

High tidal volumes to overcome markedly elevated airway resistance

Answer

High respiratory rates (>20/min) to normalise arterial PaCO2 rapidly

Answer

High extrinsic PEEP to offset auto-PEEP and reduce air trapping

Question 6

Auto-PEEP (intrinsic PEEP) in mechanically ventilated patients occurs primarily because:

Accepted Answer

Expiration is incomplete before the next breath is delivered, causing progressive air trapping

Answer

Excessively high external PEEP is applied by the clinician

Answer

Mucus plugging partially occludes the endotracheal tube lumen

Answer

Increased lung compliance in ARDS allows gas to accumulate

Question 7

Veno-venous ECMO is typically considered in ARDS patients when:

Accepted Answer

PaO2/FiO2 <80 mmHg despite optimal conventional management including prone positioning

Answer

PaO2/FiO2 <200 mmHg at initial presentation to the ICU

Answer

The patient requires more than two vasopressor agents for haemodynamic support

Answer

Bilateral pneumonia is confirmed on CT thorax with culture-positive BAL