Which of the following recommendations have been made for transport ventilators by the American ...

(Answer to Q. 1)  ANS: B
A. Incorrect response: See explanation B.
B. Correct response: Transport ventilators are typically simple devices having one or two controls, providing only one mode, no PEEP, and strictly an Fio2 of 1.0. The AHA has suggested that automatic transport ventilators meet the criteria for class I devices. These criteria are listed in the text on page 350.
C. Incorrect response: See explanation B.
D. Incorrect response: See explanation B

(Answer to Q. 2)  ANS: D
A. Incorrect response: See explanation D.
B. Incorrect response: See explanation D.
C. Incorrect response: See explanation D.
D. Correct response: Transport ventilators contain a high-pressure relief valve, which vents gas to the atmosphere at a preselected peak inspiratory pressure. The pressure limit typically is 60 to 80 cm H2O for adults and 30 to 40 cm H2O for children. Activation of the high-pressure limit is usually signaled by a visual or audible alarm to alert the operator. Since the patient in this problem is periodically reaching the high pressure limit set at only 40 cm H2O, ventilation should continue as selected.

(Answer to Q. 3)  ANS: C
A. Incorrect response: See explanation C.
B. Incorrect response: See explanation C.
C. Correct response: O2-powered breathing devices (OPD) are frequently called demand valves. A typical OPD consists of a demand valve that can be manually triggered or patient triggered. Newer OPDs limit the available airway pressure via a pressure-limiting valve, and limit the length of the inspiratory time. In terms of the inspiratory time, inspiration is terminated after 3 seconds elapse, even if the operator continues to depress the actuator. Therefore maintaining pressure on the actuator for a prolonged period will have no influence on the inspiratory time.
D. Incorrect response: See explanation C

(Answer to Q. 4)  ANS: A
A. Correct response: Transport ventilators used in prehospital care do not need (1) a variable Fio2, and (2) CPAP or a variety of ventilatory modes. Some studies have demonstrated that 95 of patients receiving prehospital ventilation during transport were apneic. Having demand flow valves adds size and weight to the ventilator, and can also increase gas consumption. Independent control knobs for Vt and respiratory rate should be available. Another important feature is the manual inhalation control, which is useful during auscultation of breath sounds to confirm proper ETT placement.
B. Incorrect response: See explanation A.
C. Incorrect response: See explanation A.

(Answer to Q. 5)  ANS: D
A. Incorrect response: See explanation D.
B. Incorrect response: See explanation D.
C. Incorrect response: See explanation D.
D. Correct response: The following equipment is essential for intrahospital transport of a mechanically ventilated patient: (1) portable monitor (ECG, arterial blood pressure, pulmonary artery catheter, intracranial pressure, etc.), (2) portable ventilator or self-inflating bag, (3) airway maintenance (intubation equipment), (4) drug box, (5) infusion pumps, and (6) stethoscope.

(Answer to Q. 6)  ANS: C
A. Incorrect response: See explanation C.
B. Incorrect response: See explanation C.
C. Correct response: Spontaneous breathing through the NRV of resuscitators has been an area of controversy. Hess and colleagues found that both inspiratory and expiratory work of breathing were elevated. Imposed work of breathing increased with the application of PEEP, and with increased patient flow demand. Measurements of work in this study were high and represented a 10- to 100-fold increase compared with the imposed work of breathing associated with common ICU ventilators. Therefore Hess and associates recommend that the practice of allowing spontaneous breathing via disposable resuscitator bags be abandoned.
D. Incorrect response: See explanation C

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