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High PEEP Haemodynamic Effects — FRCA Final MCQ

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ModerateIntensive Care MedicineHigh PEEP Haemodynamic EffectsFRCA Final

A 55-year-old man on ICU develops ARDS. PEEP is titrated upward from 10 to 16 cmH2O. Which adverse effect of high PEEP should be monitored?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Metabolic alkalosis

High PEEP increases intrathoracic pressure → reduces venous return → reduces RV preload → reduces cardiac output → hypotension. Also: barotrauma risk, increased RV afterload, hepatic/renal congestion. Monitor cardiac output, BP, and urine output when titrating PEEP.

Reference: ICS – 2024 – ARDS ventilation; RCOA – 2023 – ICM physiology