Page 654 - Clinical Application of Mechanical Ventilation

620 Chapter 19

adjusted on the basis of the culture and sensitivity report. Secretion volume and
consistency have decreased and color has changed from yellow to white.

Weaning

As the patient’s condition continued to improve, ventilatory support was gradually with-
drawn over the next 3 days. He was placed on 5 cm H O of CPAP at an F O of 0.35
I
2
2
with pressure support of 5 cm H O. After 4 hours, spontaneous ventilatory parameters
2
were measured and an arterial blood gas was obtained. The results are as follows:
f 18/min
V T 525 mL
V E 9.45 L
f/V T 34/min/L
f/V T ratio ,100/min/L is VC 2.85 L
predictive of weaning success.
MIP 244 cm H O
2
pH 7.38
PaCO 2 59 mm Hg
PaO 2 68 mm Hg
-
HCO 34 mEq/L
3
BE 17
SaO 2 92%
Hb 15.1 g/dL
HBCO 1%

Complications

A comprehensive reha- On the basis of the patient’s clinical condition and diagnostic results, he was extu-
bilitation program teaches
the patient about the disease bated and placed on 2 L/min O via nasal cannula. He was moved to the medical
2
process, self-care, diet, main- floor later that day, and was subsequently discharged 2 days later after being enrolled
tenance of an active lifestyle,
and smoking cessation. in the hospital’s comprehensive outpatient rehabilitation program. His home medica-
tions included Combivent (albuterol and ipratropium) via MDI and oral theophylline.

CASE 2: STATUS ASTHMATICUS

INTRODuCTION

P.W., a 32-year-old, 48-Kg female, was gravida 14, para 0-4-9-4, and about
Aminophylline is 21½ weeks pregnant at the time of her admission. She was evaluated for acute
commonly used to reverse
severe bronchospasm in exacerbation of asthma with a concomitant upper respiratory tract infection. The pa-
acute asthma that has not tient stated that she was “doing fine” until approximately midnight at which time she
responded to epinephrine.
began having difficulty breathing. Her dyspnea continued despite taking her routine
home-inhaled bronchodilators.

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