Waveform Tutorial Questions

1. The following pulmonary wedge pressure tracing and simultaneous ECG were
obtained in a man with urosepsis, hypotensive and mechanically ventilated on volume
assist-control mode with constant flow. What is the approximate wedge pressure?



A. -4 mmHg
B. 7 mmHg
C. 15 mmHg
D. 21 mmHg













2. The following tracing was obtained from a hypotensive patient with a pulmonary
artery catheter. The arrow marks a change in the pressure from the tip of the pulmonary
artery catheter. What accounts for the abrupt change in the character of the waveform?



A. The catheter has migrated from the pulmonary artery back into the right ventricle
B. The balloon at the tip of the catheter has burst
C. The heart has suddenly failed in its ability to pump (acute systolic dysfunction)
D. The balloon at the tip of the catheter has wedged
















3. A 34 year old with alcoholic pancreatitis is moved to the ICU for worsening
respiratory distress and hypotension. He is now intubated, sedated, and mechanically
ventilated. The abdomen is diffusely tender, very distended, and firm. The extremities
are cool and the capillary refill is poor. There are a few posterior lung crackles but no
abnormal cardiac sounds. The ECG is normal and the urine output is < 20 mL in the past
two hours. Following 1.5L normal saline a central venous catheter is placed showing a
CVP = 20mmHg. An arterial catheter is placed and the following pressure is obtained:



The most appropriate management is:

A. Dobutamine for severe LV dysfunction, perhaps due to alcoholic cardiomyopathy
B. Norepinephrine for hypotension related to the systemic inflammatory response
syndrome (SIRS)
C. tPA for possible pulmonary embolus
D. Intravenous fluids for hypovolemia

0
90
30
60
4. A 66 year old man with ischemic cardiomyopathy is admitted with cardiogenic
pulmonary edema but does not require mechanical ventilation. He is awake and alert, is
moderately dyspneic, has distended neck veins, and is breathing at 24 breaths/min. While
inserting a pulmonary artery catheter, you notice that the right atrial pressure is elevated
and does not vary with respiration. The Figure denotes the periods of inspiration and
expiration. Which one of the following best explains this lack of respiratory variation?

A. Right atrial pressure normally has little respiratory variation
B. Reduced lung compliance due to pulmonary edema reduces the respiratory impact of
respiration on pleural pressure
C. The combination of cardiac dysfunction and a well-filled circulation dampens the
effect of breathing on the right atrial pressure
D. There is probably airflow obstruction contributing to autoPEEP



I E
Pra
5. A 28 year old woman is intubated for acute respiratory failure. She is sedated, fully
ventilated, and passive. The airway pressure and flow waveforms are displayed below,
with the pressure in cmH
2
O, flow in L/s, and time in seconds. The peak value for airway
pressure is elevated at 65cmH
2
O. The dominant contributor to this elevated airway
pressure is which one of the following:

A. Increased airway resistance as might be seen in asthma
B. Increased autoPEEP such as due to premature emphysema
C. Excessive tidal volume of greater than 1000cc
D. Reduced respiratory system compliance as in lung fibrosis



6. The flow and pressure waveforms in the Figure below represent which of the following
modes of ventilation?

A. Pressure-support ventilation
B. Volume assist-control ventilation
C. Pressure-control ventilation
D. Volume synchronized intermittent ventilation




7. The flow and pressure waveforms in the Figure below were obtained during
mechanical ventilation of a patient with ARDS. The airway pressure and flow waveforms
are displayed below, with the pressure in cmH
2
O, flow in L/s, and time in seconds.
Which one of the following sets of tidal volume (V
T
) and respiratory rate (RR) is closest
to the settings in this patient?

A. V
T
450, RR 15
B. V
T
450, RR 21
C. V
T
650, RR 15
D. V
T
650, RR 21





8. A patient is ventilated with the pressure-control mode of ventilation. The Figure shows
that flow rate (arrow) falls nearly linearly throughout inspiration. Which one of the
following is the most important cause for this fall in flow?

A. Alveolar pressure rises as the lung inflates
B. Airway resistance increases throughout the breath
C. The patient is generating expiratory effort
D. The ventilator is programmed to decelerate the flow



9. A 43 year old man is intubated for acute respiratory failure. He is sedated, fully
ventilated, and passive. The airway pressure and flow waveforms are displayed below,
with the pressure in cmH
2
O, flow in L/s, and time in seconds. The peak value for airway
pressure is elevated at 40cmH
2
O. Which of the following diagnoses is most compatible
with these waveforms?

A. Status asthmaticus
B. Amyotrophic lateral sclerosis
C. Abdominal compartment syndrome
D. Pulmonary fibrosis




Case 10
What is the respiratory rate in Case 10?
A. 28
B. 60
C. 16
D. 10





Case 11
The patient in case 11 is more tachypneic than the patient in case 10
A. True
B. False
Case 12



What is the most likely explanation for the tracing in case 12?

A. Respiratory distress/Tachypnea
B. Autocycling
C. Tachycardia
D. Ventilatory circuit leak




13. A 63 year old woman with AML and neutropenic fever presents
with acute hypoxemic respiratory failure requiring intubation. Her
ideal body weight is 65 kg. Three days into her ICU stay, the bedside
nurse calls to notify you that her urine output has been less than 20
mL over each of the last 2 hours. The patient is sedated and
passive on the ventilator on an assist/control mode. Her tidal volume
is 650 mL. You are given the following waveform tracing:


Which of the following is true?
A. The patient will likely develop acute tubular necrosis
B. The patient should receive a one liter bolus of 0.9 NS
C. From the data presented, it is not possible to know whether the
patient will respond to a fluid challenge
D. Her hypotension is more likely to respond to colloid than
crystalloid, given the duration of her sepsis