AIIMS Raipur NO - 201…: Which of the following artificial ventilation mode is best suitable for a patient with respiratory arrest?

AIIMS Raipur NO - 2017 (Shift-1)

Medical & Surgical Nursing

Medium

Appeared in: AIIMS Raipur NO - 2017 (Shift-1)

Explanation

Controlled mandatory ventilation (CMV), often used as part of Assist-Control (AC) mode, is designed for patients who cannot make their own respiratory efforts.
In respiratory arrest (apnea), the patient has no drive to breathe, so the ventilator must perform 100% of the work.
CMV delivers breaths at a set rate and volume/pressure, completely independent of patient effort, making it the only suitable option for a non-breathing patient.
This mode ensures a minimum minute ventilation is achieved, which is critical for survival in respiratory arrest.

Option A: Continuous positive airway pressure (CPAP) does not deliver breaths. It only provides a constant pressure to keep the airways open. The patient must be breathing spontaneously for CPAP to be effective.
Option C: Assistant controlled mandatory ventilation (often called Assist-Control or AC) requires the patient to initiate a breath, which the ventilator then supports. A patient in respiratory arrest cannot initiate breaths.
Option D: Noninvasive positive pressure ventilation (NIPPV) is delivered via a mask and is contraindicated in patients with respiratory arrest or those who cannot protect their own airway due to the high risk of aspiration.

Visual 1: Diagram - A flowchart showing the decision-making process for selecting a ventilation mode based on the patient's respiratory drive (spontaneous, weak, or absent).
Visual 2: Infographic - A comparison table of common ventilation modes (CMV, AC, SIMV, PSV, CPAP) detailing their mechanism, patient requirements, and primary indications.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Modes of Mechanical Ventilation in acute care settings.
Selecting the correct ventilation mode is a critical, life-saving decision. Using a mode that requires patient effort (like CPAP or PSV) on an apneic patient would lead to further hypoxia and death.
Nurses play a vital role in monitoring patients on mechanical ventilation, assessing for patient-ventilator synchrony, ensuring the airway is secure, and responding to alarms.
What if? If a patient on CMV begins to show spontaneous respiratory efforts, the mode may be changed to Assist-Control (AC) or Synchronized Intermittent Mandatory Ventilation (SIMV) to allow the patient to participate in breathing, which can improve comfort and help wean them from the ventilator.

How to Approach the Question

First, identify the key clinical condition in the question stem: 'respiratory arrest'.
Define what respiratory arrest means in terms of patient effort. It means the complete absence of spontaneous breathing.
Next, analyze each option based on the level of patient effort it requires.
Option A (CPAP) and D (NIPPV) require spontaneous breathing, so they are incorrect.
Option C (Assist-Control) requires the patient to trigger the ventilator, which is not possible in arrest.
Option B (Controlled Mandatory Ventilation) takes full control of breathing, which directly matches the needs of a patient with no respiratory effort. Therefore, it is the correct answer.

Concept Tested & Keywords

Concept Tested: Modes of Mechanical Ventilation
Stem keywords: artificial ventilation, respiratory arrest
Lead-in keywords: best suitable
Clinical cues: The patient's condition is 'respiratory arrest', which implies a complete cessation of breathing and absence of respiratory drive.

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E6 Nursing Brunner Adult Health 3SA Vol 2 Part 2 p. 3067-3079