Neonatal Nurse Practitioner Practice Exam

According to the Golden Rule for RDS, the starting PEEP level for HFOV should be set at what measurement?

1. 1-2 cm above the MAP

2. 2-5 cm above the MAP

3. 1-4 cm above the MAP

4. 4-6 cm above the MAP

The correct answer is: 1-4 cm above the MAP

The correct answer reflects the appropriate starting level of Positive End-Expiratory Pressure (PEEP) for High-Frequency Oscillatory Ventilation (HFOV) in the management of Respiratory Distress Syndrome (RDS). The guideline of setting PEEP at 1-4 cm above the Mean Airway Pressure (MAP) is established to optimize lung recruitment and improve oxygenation while minimizing the risk of ventilator-induced lung injury. This range assists in maintaining adequate alveolar recruitment and prevents atelectasis, facilitating enhanced gas exchange in neonates suffering from RDS. Choosing a PEEP level that is too low may result in insufficient recruitment of the collapsed alveoli, whereas setting it too high could increase intrathoracic pressure, hindering venous return and potentially causing hemodynamic instability. Therefore, starting within the 1-4 cm range is crucial as it provides a balance between recruitment and over-distension of the alveoli, aligning with clinical best practices for managing this vulnerable population.