Page 658 - Clinical Application of Mechanical Ventilation

624 Chapter 19

P INSP 30 cm H O
2
F O 2 50%
I
PEEP 10 cm H O
2
She was becoming more alert and oriented to time and place and was appro-
priately changed to SIMV with pressure support (PS) to supplement her own
efforts to breathe. She appeared calm at first but became increasingly restless
and combative over the afternoon and evening. She frequently motioned for
the endotracheal tube to be removed and was frustrated about her inability
to talk.

Patient Management

In addition to the ventilator management strategies, adequate hydration was pro-
vided to promote mucociliary clearance and bronchopulmonary hygiene. Inhaled
bronchodilators, glucocorticosteroids, and mast cell stabilizers (nonacutely) were
used to bring the bronchospasm and inflammation under control.

Key Medications

The patient was treated with IV aminophylline, beta adrenergics (Proventil® and
Serevent®) via MDI and given inline through the ventilator circuit every 3 to
4 hours. These served to control the symptoms associated with asthma while she
Intal is not given in acute
asthma episodes but is used was started on triacinolone acetonide (Azmacort®), a corticosteroid inhaler to con-
as a prophylactic measure trol inflammation. She was also started on two puffs of cromolyn sodium (Intal®)
to control airway hyper-
reactivity. to help prevent further degranulation of mast cell responsible for hyper-reactive
airway disease and future attacks.

Weaning

The weaning process was uneventful as the patient continued to improve. She was
eventually placed on CPAP without pressure support for extubation trial. Her
spontaneous breathing parameters revealed the following results:

f 5 15 V 5 8.1 L Average V 5 0.54 L VC 5 2.19 L MIP 5 243 cm H O
T
E
2
An f/V T ratio (RSBI or rapid f/V 5 28/min/L
shallow breathing index) of T
less than 100/min/L correlates At some point, the patient extubated herself while being restrained. The decision
with weaning success.
was made to provide nasal cannula at 6 L/min, which maintained her oxygen satura-
tions above 90%.
Complications

Her oxygen demands decreased over several days where she continued with her
bronchodilators, was weaned to room air, and was discharged after 6 days. There
were no apparent complications throughout her hospital stay and she was advised

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