ICU Vivas · ARDS & lung protection
Ventilator data: driving pressure and compliance in severe ARDS
A CICM cross-table data viva on ventilator number interpretation in ARDS. The candidate reads the mode and settings, calculates the driving pressure and static compliance from the plateau and PEEP, classifies severity from the PaO2/FiO2 ratio, and identifies an unsafe lung strain to titrate against — the bedside skill that ARDSNet and the driving-pressure data made central.
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Prompt
A ventilator data panel and a simultaneous arterial gas from an intubated patient with severe ARDS — interpret the numbers, calculate the derived variables, and state whether the lung is being ventilated safely.
Stimulus
A 58-year-old woman is ventilated on day 2 of severe ARDS from pneumonia. You are shown the ventilator panel and a simultaneous arterial gas. The numbers are:
| Variable | Value |
|---|---|
| Mode | Volume-controlled ventilation |
| Tidal volume | 360 mL (6 mL/kg predicted body weight) |
| Respiratory rate | 28/min |
| FiO2 | 0.8 |
| Set PEEP | 12 cmH2O |
| Peak inspiratory pressure | 34 cmH2O |
| Plateau pressure (inspiratory hold) | 30 cmH2O |
| PaO2 (arterial gas) | 56 mmHg |
| PaCO2 | 48 mmHg |
| pH | 7.30 |
Interpret the panel, calculate the derived variables, and judge whether the lung is being ventilated safely.[1]
References6ShowHide
- [1]Brower RG, Matthay MA, Morris A, et al. Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress Syndrome. New England Journal of Medicine, 2000.PMID 10793162
- [2]Amato MBP, et al. Driving Pressure and Survival in the Acute Respiratory Distress Syndrome. New England Journal of Medicine, 2015.PMID 25693014
- [3]Gattinoni L, et al. Regional Physiology of ARDS. Critical Care, 2017.PMID 29297365
- [4]Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute Respiratory Distress Syndrome: The Berlin Definition. JAMA, 2012.PMID 22797452
- [5]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
- [6]Marino PL The ICU Book. 4th edition, Lippincott Williams & Wilkins, 2014.