PBCFR Protocol Practice Test

In obstructive lung disease like COPD and asthma, expiration is slow and air trapping is common. When you use positive pressure ventilation, short pauses can prevent complete exhalation, increasing air trapping and raising intrathoracic pressure, which can worsen hemodynamics. To allow full exhalation between breaths, the protocol recommends a relatively long pause—around 20 to 40 seconds—so the lungs can empty before the next insufflation. Shorter pauses won’t let exhalation finish and can worsen hyperinflation, while waiting too long (like a minute) would deprive the patient of needed ventilation and worsen hypotension. So, a 20–40 second pause best matches the goal of permitting complete exhalation in this context.