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A 67-year-old-male with bullous emphysema is scheduled for a bullectomy to prevent air-leak syndrome. The AG-ACNP knows which of the following patients would not be suited for a bullectomy:

A 48-year-old male with no prior medical history is admitted with community-acquired pneumonia and severe acute respiratory distress syndrome (ARDS). On day 1 of his illness, he is admitted to your ICU on volume control-assist control ventilation with a VT of 4 mL/kg IBW, respiratory rate 32 breaths per minute, PEEP 14 cm H2O, and FiO2 1.0. On those settings, he is found to be hypoxemic with a SaO2 of 86% with an ABG that demonstrates pH 7.28 PCO2 65 mm Hg and PaO2 55 mm Hg. Which of the following interventions is most likely to improve his survival?

An 84-year-old male with severe chronic obstructive pulmonary disease (FEV1 20% predicted, on 4 L/min home O2) is admitted with severe hypoxemic respiratory failure due to a Streptococcus pneumoniae infection. He is intubated and placed on volume control-assist control ventilation with a set TV of 400 mL (6.5 mL/kg IBW), PEEP of 8 cm H2O and a respiratory rate of 30 breaths per minute. When the paralytic used for intubation wears off, the patient is noted to be triggering additional spontaneous breaths with a total respiratory rate of 36 breaths per minute, and his exhaled TVs vary from 100 to 800 mL. During an end-expiratory pause, his airway pressure is 18 cm H2O. Which of the following is the MOST accurate statement regarding his ventilator settings?

A 42-year-old obese female with OSA, diabetes mellitus, and hypertension is admitted for community-acquired pneumonia. After multiple attempts, she is emergently intubated with ET tube size 8.5. She has been intubated for 7 days and today she has tolerated the spontaneous breathing trial. What is the next step?

A 90-year-old female with a history of atrial fibrillation on Eliquis presents with right rib pain and dyspnea after a mechanical fall from standing. She is hemodynamically stable, but her chest CT reveals right rib fractures 3 to 5 with associated hemothorax. The next best step in management includes:

A 79-year-old male with a history of hypertension, dyslipidemia, and type-2 diabetes mellitus presents to the emergency department complaining of increasing shortness of breath, over the past 4 hours. Arterial blood gas (ABG) analysis at room air shows: PaO2 54 mm Hg, PaCO2 28 mm Hg, pH 7.48, HCO3 22 mEq/L. Upon admission, the patient is administered oxygen via a face mask with oxygen reservoir at 15 L/min. The SpO2 raises from 87% to 99%. Thirty minutes later, the patient is still dyspneic (respiratory rate: 32 breaths/min). Noninvasive blood pressure is 180/85 mm Hg, heart rate is 100 bpm. ABG now shows: PaO2 249 mm Hg, PaCO2 27 mm Hg. Chest auscultation reveals mild bilateral crackles at the bases of the lungs and mild wheezing. Body temperature is 36.2°C, WBC 6500/mL, creatinine 1.8 mg/dL, lactate 1.4 mmol/L. What is the MOST likely diagnosis?

A 59-year-old male presents with complaints of chest tightness and shortness of breath. He has a medical history of CAD, hypertension, and hyperlipidemia. Family history is positive for CAD, hypertension, hyperlipidemia, and asthma. His vital signs are: heart rate 110, blood pressure 189/106, respiratory rate 28, and SpO2 96%. On exam the AG-ACNP appreciates bilateral expiratory wheezes, but no rubs, gallops, or murmurs. Capillary refill time is less than 3 seconds. Which medication should be avoided until asthma has been ruled out?

The gold standard for the diagnosis of OSA-hypopnea syndrome is:

Neuromuscular blocking drugs may be beneficial in the management of a patient with ARDS because of which one of the following?

A 68-year-old woman with HIV is admitted to the ICU with respiratory failure secondary to pneumocystis pneumonia, requiring intubation and mechanical ventilation. A chest CT scan was performed before intubation and demonstrated cystic changes throughout the lungs, thought to be a sequela of past pneumocystis infection, with superimposed diffuse ground glass opacities. Her ventilator is set on volume assist-control, TV 6 mL/kg, respiratory rate 16 breaths per minute, FiO2 0.8, and PEEP of 10 cm H2O. On day 2 of her critical illness, her ventilator suddenly alarms for elevated peak pressures. She is observed to be deeply sedated and breathing passively on the ventilator. The peak pressure has risen from 25 cm H2O several hours before 50 cm H2O. The patient has simultaneously experienced oxygen desaturation from 95% to 90%. She is otherwise hemodynamically stable. A chest radiograph is ordered. An inspiratory hold maneuver is performed and her plateau pressure is 20 cm H2O. Which of the following is the MOST LIKELY explanation for this acute event?