6 th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists. Course Test Results for the accreditation of the acquired knowledge

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1 6 th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists Course Test Results for the accreditation of the acquired knowledge

2 Q. Concerning the mechanics of the newborn s respiratory system we can say please select the false answer They have a low FRC They need an auto-peep of cm HO to avoid atelectasis The lung compliance is usually higher than the thorax compliance The lung compliance is lower than in adults Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

3 Q. Concerning the mechanics of the newborn s respiratory system we can say please select the false answer They have a low FRC 5% They need an auto-peep of cm HO to avoid atelectasis % The lung compliance is usually higher than the thorax compliance % The lung compliance is lower than in adults % Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

4 Q. Ventilation modes please select the false statement When there are patient leaks it is better to use pressure control mode Pressure support is complicated to program in pediatrics and should be avoided For children under 0 kg, pressure support mode can be set with a trigger of 0.5 L/min. and pressure support at 5 cm HO For patients weighing more than 0 kg, pressure support ventilation should be set with a trigger of L/min. and pressure support at 0 cm HO Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

5 Q. Ventilation modes please select the false statement When there are patient leaks it is better to use pressure control mode 9% Pressure support is complicated to program in pediatrics and should be avoided 55% For children under 0 kg, pressure support mode can be set with a trigger of 0.5 L/min. and pressure support at 5 cm HO % For patients weighing more than 0 kg, pressure support ventilation should be set with a trigger of L/min. and pressure support at 0 cm HO % 5 Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

6 Q. Concerning ventilation with a circle circuit we can say please select the false statement 0 Anesthesia workstations do not have any special considerations in pediatrics ml of tidal volume is lost for every liter of the machine s internal volume and every cm HO of pressure reached inside the machine Compliance compensation systems have been designed to administer more than the set volume to compensate for the compressed volume trapped inside the machine In each ventilation, the amount of tidal volume lost depends on how efficient the compensation system is 6 Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

7 Q. Concerning ventilation with a circle circuit we can say please select the false statement Anesthesia workstations do not have any special considerations in pediatrics ml of tidal volume is lost for every liter of the machine s internal volume and every cm HO of pressure reached inside the machine Compliance compensation systems have been designed to administer more than the set volume to compensate for the compressed volume trapped inside the machine In each ventilation, the amount of tidal volume lost depends on how efficient the compensation system is 7 Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

8 Q. Concerning recruitment maneuvers (RM) we can say please select the false statement They must be done before setting the PEEP The major clinical risk is to provoke hypotension in a patient with low preload In healthy lungs you can directly use PEEP without making any RM If you do not reach enough PIP to open all the alveoli, you won t see any benefits 8 Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

9 Q. Concerning recruitment maneuvers (RM) we can say please select the false statement They must be done before setting the PEEP 5% The major clinical risk is to provoke hypotension in a patient with low preload 5% In healthy lungs you can directly use PEEP without making any RM 9% If you do not reach enough PIP to open all the alveoli, you won t see any benefits 9 Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

10 Q5. Concerning RM and anesthesia we can say please select the false statement The safest way to perform RM is in pressure control mode During the RM it is better to keep the driving pressure constant at 5 cm HO The RM recommended in children is PCV (PIP of 0 cm HO and 5 cm HO of PEEP) To set the final PEEP you first have to calculate the collapse PEEP 0 Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

11 Q5. Concerning RM and anesthesia we can say please select the false statement The safest way to perform RM is in pressure control mode During the RM it is better to keep the driving pressure constant at 5 cm HO 86% The RM recommended in children is PCV (PIP of 0 cm HO and 5 cm HO of PEEP) To set the final PEEP you first have to calculate the collapse PEEP % Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

12 Q6. Concerning the use of PEEP in anesthesia please select the true statement It is not necessary to use PEEP in anesthesia PEEP higher than 0 cm HO during a RM has major hemodynamic repercussions always It is better to routinely give 5 cm HO of PEEP to all patients PEEP should be set individually for each patient Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

13 Q6. Concerning the use of PEEP in anesthesia please select the true statement It is not necessary to use PEEP in anesthesia PEEP higher than 0 cm HO during a RM has major hemodynamic repercussions always 5% It is better to routinely give 5 cm HO of PEEP to all patients PEEP should be set individually for each patient 95% Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

14 Q7. How to evaluate an anesthesia machine please select the false statement The most important point is power of insufflation Pressure-time curves in PCV can help you to evaluate the performance of the machine The internal volume should be as small as possible The flow trigger sensitivity is not important Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

15 Q7. How to evaluate an anesthesia machine please select the false statement The most important point is power of insufflation % Pressure-time curves in PCV can help you to evaluate the performance of the machine 9% The internal volume should be as small as possible 5% The flow trigger sensitivity is not important 7% 5 Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

16 Q8. About pressure support mode we can say please select the false statement 0 It helps in fast-track anesthesia The flow trigger must be set up at 5 L/min. Pressure support must be set around 5 cm HO in children under 0 kg Always set a backup mode 6 Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

17 Q8. About pressure support mode we can say please select the false statement It helps in fast-track anesthesia The flow trigger must be set up at 5 L/min. Pressure support must be set around 5 cm HO in children under 0 kg Always set a backup mode 7 Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

18 Q9. Ventilatory monitoring please select the true statement The pressure-time curve in pressure mode gives you a lot of information about airway resistances The pressure-time curve in volume mode gives you a lot of information about ventilator performance The pressure-time curve is the best and easiest way to detect leaks The flow-time curve helps you to set proper inspiratory and expiratory times 8 Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

19 Q9. Ventilatory monitoring please select the true statement The pressure-time curve in pressure mode gives you a lot of information about airway resistances % The pressure-time curve in volume mode gives you a lot of information about ventilator performance 5% The pressure-time curve is the best and easiest way to detect leaks % The flow-time curve helps you to set proper inspiratory and expiratory times 59% 9 Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

20 Q0. About electrical impedance tomography (EIT) please select the false statement 0 EIT is a real-time non-radiation imaging method to see the lungs EIT shows the tidal volume distribution in each breath, in real-time EIT contraindications are pacemakers, cardioverters, defibrillators, MR, electrical scalpels With EIT you cannot detect a pneumothorax 0 Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

21 Q0. About electrical impedance tomography (EIT) please select the false statement EIT is a real-time non-radiation imaging method to see the lungs EIT shows the tidal volume distribution in each breath, in real-time EIT contraindications are pacemakers, cardioverters, defibrillators, MR, electrical scalpels With EIT you cannot detect a pneumothorax Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

22 Q. Changing the fresh gas flow please select the false statement A high fresh gas flow (> 6 L) guaranteed, that changes in the vapor settings reach the patient very fast (short time constant) The lower the fresh gas flow, the longer is the time constant of a breathing system The washing out effect of volatile anesthetics by using minimal flow anesthesia is very fast When the flow is being reduced the setting on the vapor must be increased to maintain the same narcotic level Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

23 Q. Changing the fresh gas flow please select the false statement A high fresh gas flow (> 6 L) guaranteed, that changes in the vapor settings reach the patient very fast (short time constant 9% The lower the fresh gas flow, the longer is the time constant of a breathing system The washing out effect of volatile anesthetics by using minimal flow anesthesia is very fast 8% When the flow is being reduced the setting on the vapor must be increased to maintain the same narcotic level 9% Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

24 Q. The approximate O Consumption per kg body weight during the anesthesia is? Describes in the formula by Dr. Smith 5.5 ml/kg Describes in the formula by Dr. Baum.5 ml/kg Describes in the formula by Dr. Lachmann 0 ml/kg Describes in the formula by Dr. Brody.5 ml/kg Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

25 Q. The approximate O Consumption per kg body weight during the anesthesia is? Describes in the formula by Dr. Smith 5.5 ml/kg Describes in the formula by Dr. Baum.5 ml/kg 5% Describes in the formula by Dr. Lachmann 0 ml/kg % Describes in the formula by Dr. Brody.5 ml/kg 8% 5 Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

26 Q. Low flow anesthetic techniques are suitable for? Short term anesthesia with a face mask Inadequate gas monitoring Long term anesthesia Procedures with imperfectly gas-tight airways (i.e., bronchoscopy) 6 Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

27 Q. Low flow anesthetic techniques are suitable for? Short term anesthesia with a face mask Inadequate gas monitoring Long term anesthesia 0 Procedures with imperfectly gas-tight airways (i.e., bronchoscopy) 7 Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

28 Q. About Nitrous oxide we can say 0 NO is forbidden in low flow anesthesia The use prevents vomiting It leads to a reduction of supplementary opioids and anesthetics It cans stabile the patient with increased intracranial pressure 8 Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

29 Q. About Nitrous oxide we can say NO is forbidden in low flow anesthesia The use prevents vomiting It leads to a reduction of supplementary opioids and anesthetics 9 It cans stabile the patient with increased intracranial pressure 9 Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

30 Q5. About the duration of initial high flow phase of Low Flow Anesthesia please select the false statement 0 Sufficient denitrogenation Reduce the time constant of the anesthetic gases Rapid warming and humidifying of the gas composition Establishing of the desired anesthetic concentration 0 Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

31 Q5. About the duration of initial high flow phase of Low Flow Anesthesia please select the false statement Sufficient denitrogenation 5% Reduce the time constant of the anesthetic gases Rapid warming und humidifying of the gas composition 6 Establishing of the desired anesthetic concentration 5% Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

32 Q6. Lung protective mechanical ventilation please select the false statement 0 Low tidal volume can be safely applied without atelectasis formation Reduce tidal volume to obtain a driving pressure less than 5 cm H0 Recruitment maneuver is needed to reopen non-aerated lung regions and then set an individual PEEP Does not effect to prevent postoperative pulmonary complications Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

33 Q6. Lung protective mechanical ventilation please select the false statement Low tidal volume can be safely applied without atelectasis formation 5% Reduce tidal volume to obtain a driving pressure less than 5 cm H0 Recruitment maneuver is needed to reopen non-aerated lung regions and then set an individual PEEP Does not effect to prevent postoperative pulmonary complications 65% Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

34 Q7. Alveolar recruitment maneuver please select the true statement Is a pressure and time dependent mechanism Requires always a fixed PEEP Requires always an invasive hemodynamic monitoring An increase of FIO is always mandatory before the RM Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

35 Q7. Alveolar recruitment maneuver please select the true statement Is a pressure and time dependent mechanism 9% Requires always a fixed PEEP 5% Requires always an invasive hemodynamic monitoring 5% An increase of FIO is always mandatory before the RM 5 Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

36 Q8. Non-invasive ventilation during preoxygenation please select the true statement 0 Is effective to prevent arterial desaturation in ICU patients Can not be performed using anesthesia machine A pressure support (PSV) level of > 0 cm HO is required in most patients Is associated always with intra-gastric air insufflation 6 Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

37 Q8. Non-invasive ventilation during preoxygenation please select the true statement Is effective to prevent arterial desaturation in ICU patients 8 Can not be performed using anesthesia machine 5% A pressure support (PSV) level of > 0 cm HO is required in most patients Is associated always with intra-gastric air insufflation 5% 7 Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

38 Q9. Non-invasive ventilation during the postoperative period () please select the true statement Is always contraindicated after upper digestive anastomoses Is not indicated when a nasogastric tube is present A dedicated NIV device is required PSV level should be ideally set to obtain a patient comfort 8 Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

39 Q9. Non-invasive ventilation during the postoperative period () please select the true statement Is always contraindicated after upper digestive anastomoses Is not indicated when a nasogastric tube is present A dedicated NIV device is required 9% PSV level should be ideally set to obtain a patient comfort 6% 9 Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

40 Q0. Non-invasive ventilation during the postoperative period () please select the false statement 0 Air leaks are frequent Pressure triggers avoids auto-triggering Expiratory cycling should be set individually Asynchronies are more frequent during NIV than with invasive ventilation 0 Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

41 Q0. Non-invasive ventilation during the postoperative period () please select the false statement Air leaks are frequent Pressure triggers avoids auto-triggering Expiratory cycling should be set individually Asynchronies are more frequent during NIV than with invasive ventilation Test 6th Accredited Advanced Mechanical Ventilation Course for Anesthesiologists 06

42 Thank you for your attention.

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