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Severe ARDS — RCPSC IM MCQ

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HardCritical CareSevere ARDSRCPSC IM

A ventilated patient with near-fatal asthma has severe airflow obstruction, rising intrinsic PEEP and hypotension after intubation. Which ventilator adjustment best addresses dynamic hyperinflation?

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

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Correct answer: B — Lower minute ventilation and lengthen expiration, accepting permissive hypercapnia

The best answer is “Lower minute ventilation and lengthen expiration, accepting permissive hypercapnia”. Obstructed lungs require time to empty. Lower respiratory rate and tidal volume with high inspiratory flow lengthen expiration, reduce breath stacking and improve venous return; permissive hypercapnia is safer than escalating minute ventilation, which worsens intrinsic PEEP and barotrauma.

Reference: Canadian Thoracic Society, severe asthma guideline resources: https://cts-sct.ca/guideline-library/