Sat27November0556PM 23

Which of the following statements is most accurate concerning the management of the adult respiratory distress syndrome (ARDS) in a patient with severe sepsis?

(Please select 1 option)

Turning the patient into the prone position is not recommended as a rescue strategy

The ventilator strategy should employ a relatively high level of positive end-expiratory pressure (PEEP) Correct

Non-invasive ventilation should be attempted before endotracheal intubation where possible

Pulmonary artery catheters usefully improve outcomes in patients with both ARDS and sepsis

A target tidal volume of 6 ml/kg actual body weight should be set

Explanation

ARDS is a common complication of severe sepsis. The ARDSnet guidelines feature prominently in the Surviving Sepsis guidelines, with a special emphasis on factors that are important in severe sepsis.

The target tidal volume is based on ideal, rather than actual body weight. Fat has no alveoli! A target tidal volume of 6 ml/kg ideal body weight should be set maintaining plateau pressures of less than 30 cmH2O.

A high-PEEP strategy is recommended to reduce atelectotrauma.

Turning the patient prone and recruitment manoeuvres are recommended for worsening hypoxaemia.

Pulmonary artery catheters should not be used routinely and a conservative fluid strategy should be used where possible.

Non-invasive ventilation (NIV) should not be routinely used and only in carefully considered in a minority of cases.

Reference:

Surviving Sepsis Campaign. Recommendations: Other Supportive Therapy of Severe Sepsis.

Answer Statistics

1

1%

2

69%

3

9%

4

1%

5

22%

Times answered: 349