Page 652 - Clinical Application of Mechanical Ventilation

618 Chapter 19

Initial Settings

On the basis of clinical and laboratory data, a decision was made to assist the pa-
In the alert and coopera- tient’s ventilation. In lieu of endotracheal intubation, bilevel positive airway pres-
tive patient with intact airway
defenses, noninvasive ventila- sure (bilevel PAP or BiPAP®) was initiated via nasal mask at the settings below.
tion can provide ventilatory The IPAP and EPAP levels were titrated to 15/5 cm H O resulting in an SpO of
support without the risks 2 2
associated with intubation. around 90%.

Mode Spontaneous
IPAP 15 cm H O
2
EPAP 5 cm H O
2
Sup. O 2 2 L/min

The patient was poorly compliant with the therapy, removing the mask frequently,
complaining of “not getting enough air.” After one hour, an arterial blood gas was
obtained and revealed the following:

pH 7.25
PaCO 2 80 mm Hg
PaO 2 56 mm Hg
-
HCO 34 mEq/L
3
BE 13
SaO 2 86%
Hb 16 g/dL
HBCO 2%

On the basis of the worsening ventilatory failure despite noninvasive ventilatory
assistance, the patient was intubated with a size 8.5 endotracheal tube, and volume-
controlled ventilation was initiated on the following settings:
Mode CMV
V T 750 mL
f 10/min
Flow 55 L/min
F O 2 0.40
I
PEEP 5 cm H O
2
Flow Trigger 3 L/min

After 30 min, an arterial blood gas was obtained and revealed the following:

pH 7.37
PaCO 2 65 mm Hg
PaO 2 88 mm Hg
-
HCO 36 mEq/L
3
BE 16
SaO 2 96%
Hb 16 g/dL
HBCO 1%

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