Pediatric CCRN Respiratory Flashcards

What is the RECOMMENDED initial PEEP setting when initiating mechanical ventilation in a child with moderate pediatric ARDS?

Answer: 8–10 cmH2O

Current pediatric ARDS guidelines recommend a PEEP of 8–10 cmH2O for moderate ARDS to maintain alveolar recruitment and prevent cyclic atelectasis.

A 9-month-old intubated for RSV bronchiolitis has a sudden decrease in SpO2 and increased peak inspiratory pressures. The DOPE mnemonic is used. After repositioning the ET tube and ruling out obstruction, the NEXT step is:

Answer: Check for pneumothorax by CXR or transillumination

The 'E' in DOPE stands for Equipment failure/pneumothorax — after ruling out displacement and obstruction, evaluate for pneumothorax with CXR or transillumination in infants.

Which inhaled agent is used as rescue therapy in pediatric acute severe asthma unresponsive to standard bronchodilators?

Answer: Heliox (helium-oxygen mixture)

Heliox reduces gas turbulence in narrowed airways, decreasing work of breathing and improving distal bronchodilator delivery in severe asthma refractory to standard therapy.

A neonate at 28 weeks gestation requires surfactant therapy. What is the PRIMARY mechanism by which exogenous surfactant improves oxygenation?

Answer: Decreases alveolar surface tension to prevent collapse

Exogenous surfactant replaces deficient endogenous surfactant, reducing alveolar surface tension and preventing atelectasis to improve ventilation-perfusion matching and oxygenation.

Which finding on a chest X-ray is CHARACTERISTIC of surfactant deficiency (respiratory distress syndrome) in a premature neonate?

Answer: Diffuse ground-glass opacity with air bronchograms

RDS produces a diffuse ground-glass or 'white-out' pattern with air bronchograms on CXR due to widespread atelectasis from surfactant deficiency in premature lungs.

A 6-year-old on high-frequency oscillatory ventilation (HFOV) for ARDS has improved oxygenation but worsening CO2 retention. Which adjustment corrects this?

Answer: Increase amplitude (delta P)

In HFOV, CO2 elimination is controlled by amplitude (delta P) — increasing amplitude improves the tidal oscillation volume, enhancing CO2 washout.