American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the primary goal when implementing permissive hypercapnia in ARDS management?

1. To achieve a pH below 7.0

2. To maintain adequate oxygenation

3. To prevent respiratory acidosis

4. To allow higher CO2 levels without compromising pH

The correct answer is: To allow higher CO2 levels without compromising pH

The primary goal of implementing permissive hypercapnia in the management of Acute Respiratory Distress Syndrome (ARDS) is to allow higher carbon dioxide levels in the blood without compromising the pH. This concept acknowledges that while increasing CO2 levels may lead to respiratory acidosis, maintaining low tidal volumes during mechanical ventilation can minimize ventilator-induced lung injury. By allowing the patient to tolerate higher levels of carbon dioxide, clinicians can reduce the barotrauma and volutrauma that can occur with traditional ventilation strategies aimed at minute ventilation. This approach targets the preservation of the lung's integrity and function while still ensuring effective oxygen delivery and avoiding potential damage from mechanical ventilation techniques. The management of patients with ARDS often requires a careful balance between ensuring adequate oxygenation and minimizing lung injury, and permissive hypercapnia facilitates this balance by allowing for elevated CO2 levels while maintaining pH within acceptable limits, rather than pursuing a strict target for pH control.