Page 656 - Clinical Application of Mechanical Ventilation

622 Chapter 19

Based on the clinical signs and anticipated progression of asthma, the decision
was made to perform elective intubation and prophylactic mechanical ventilation.
Initial Settings

The patient was initially set on assist/control (AC) mode at a frequency of 10/min, V of
T
500 mL (approx. 10 mL/Kg ideal body weight), F O of 90%, and PEEP of 5 cm H O.
2
2
I
Ideal Body Weight:
Male: 50 1 2.3 (Height in Inches 2 60) 3 6 mL
Female: 45.5 1 2.3 (Height in Inches 2 60) 3 6 mL

The peak flow was increased to match her inspiratory demand, approaching
110 L/min due to her high inspiratory flow rate requirement. Every effort was made
to reduce the work of breathing and decrease her anxiety level from a ventilatory
standpoint. Blood gases obtained revealed the following:

pH 7.43
PaCO 2 33 mm Hg
PaO 2 55 mm Hg
-
HCO 21.3 mEq/L
3
Hb 12.4 g %
SpO 2 90%
Mode A/C
f 10/min
V T 500 mL
F O 2 90%
I
PEEP 5 cm H O
2
Although pharmacologic sedation is generally not recommended for asthmatic
PC-IRV may improve patients, she was medicated and changed to pressure-controlled inverse ratio ven-
oxygenation and minimize
occurrence of barotrauma. tilation (PC-IRV) mode at a 2:1 ratio to improve oxygenation and prevent baro-
trauma related to positive pressure ventilation. She was started at a frequency of
20/min, an inspiratory pressure of 40 cm H O, T of 0.5 sec, F O of 60%, and
I
2
I
2
PEEP of 10 cm H O. Blood gases were as follows:
2
pH 7.36
PaCO 2 44 mm Hg
PaO 2 64 mm Hg
-
HCO 24 mEq/L
3
Hb 11.8 g %
SpO 2 92%
Mode PC-IRV
T I 0.5 sec
I:E ratio 2:1
f 20/min
PIP 40 cm H O
2
F O 2 60%
I
PEEP 10 cm H O
2

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