Page 653 - Clinical Application of Mechanical Ventilation
P. 653
Case Studies 619
On the basis of the blood gas, an order was written to titrate the patient’s F O to
2
I
maintain the SpO $92%. No other changes were made to the ventilatory param-
2
eters. Albuterol orders were changed to MDI, 6 puffs inline Q4H. The patient was
suctioned prn for moderate amounts of thick pale yellow secretions.
Patient Monitoring
Over the course of the next 72 hours the patient was rested on the ventilator and
In order to minimize treated appropriately for his pneumonia and right heart failure. The patient re-
theophylline toxicity, the
therapeutic range for serum mained alert and cooperative with his care. A chest radiograph done on day three
theophylline level should be of ICU admission demonstrated clearing of the pneumonic process in the RLL.
kept from 5 to 15 mcg/mL.
Findings characteristic of emphysema were also present, including hyperlucent
lung fields, a flattened diaphragm, widely spaced ribs, and a narrow heart shadow.
Serum theophylline levels were monitored daily, averaging 9 mcg/mL.
The ventilator settings were adjusted appropriately and currently are:
Mode SIMV
V T 750 mL
f 6/min
PIF 55 L/min
F O 2 0.35
I
PEEP 5 cm H O
2
PS 7 cm H O
2
Flow Trigger 3 L/min
Spontaneous Parameters:
Spont. f 12/min
Spont. V T 550 mL
VC 2.21 L
MIP 236 cm H O
2
The arterial blood gas drawn on the current ventilator settings shows:
pH 7.39
PaCO 2 58 mm Hg
PaO 2 74 mm Hg
-
HCO 34 mEq/L
3
BE 17
SaO 2 94%
Hb 15.5 g/dL
HBCO 1%
Patient Management
The patient’s vital signs have normalized and, along with ventilator care, fluid status
was normalized and bronchodilator therapy was continued to relieve bronchospasm
and help promote mucociliary clearance. Antibiotic therapy was continued and
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