Page 657 - Clinical Application of Mechanical Ventilation
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Case Studies 623
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Figure 19-1 Status asthmaticus. Hyperinflation is evident on this chest radiograph since the
distance between the adjacent ribs in widened (1) and the diaphragm is depressed (2). Infiltrates
or areas of edema are noted (3). The central venous line (4) is also visible on this chest radiograph.
No changes in her care or ventilator parameters were made at that time. Breath
sounds revealed wheezes and coarse rhonchi throughout all lung fields. She contin-
ued to receive her bronchodilator therapy and was suctioned appropriately.
Patient Monitoring
The chest radiograph shows the characteristic hyperinflation of the lungs. The dis-
tance between the adjacent ribs is widened and the diaphragm is depressed. Infiltrates
or areas of edema are also noted on the chest radiograph (Figure 19-1). Other than
these signs, the chest radiograph is normal.
Over the next 3 days, the ventilator settings were weaned appropriately and the set-
tings were pressure-controlled at 30 cm H O, T of 0.7 sec for a 2:1 ratio, F O of
I
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2
I
50%, and PEEP of 10 cm H O. She was beginning to show signs of reduced inflam-
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mation of her airway with only occasional inspiratory and expiratory wheezes. Small
The therapeutic range amounts of cloudy, clear secretions were suctioned from her endotracheal tube. Peak
of serum theophylline is and trough levels of serum theophylline were drawn to monitor for possible toxicity.
between 5 and 15 mcg/mL.
Blood gas results were as follows:
pH 7.43
PaCO 2 36 mm Hg
PaO 2 78 mm Hg
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HCO 23 mEq/L
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Hb 12 g %
SpO 2 93%
Mode IR-PCV
T I 0.7 sec
I:E ratio 2:1
f 20/min
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