Page 660 - Clinical Application of Mechanical Ventilation

626 Chapter 19

After her exam in the ER, she received two units of packed red blood cells
Discharge PaCO 2 (50 mm (RBCs) and one unit of plasma to treat her low hematocrit. Due to her acute and
Hg) will serve as the baseline
and target value for subsequent severe condition, she was taken to the operating room for abdominal exploratory
blood gases. surgery.

Indications
Blood transfusion is
indicated because of T hema-
tocrit and T platelets. The patient was heavily sedated during her abdominal exploratory surgery and re-
quired large amounts of IV fluids, including blood products to maintain her blood
pressure during surgery and to increase her low hematocrit level. A bleeding gastric
ulcer and a perforated duodenal ulcer were found. They were repaired without com-
plications. The patient was returned to the ICU, intubated, and placed on mechani-
cal ventilation for postoperative recovery.

Initial Settings

The patient was intubated with a size 8.0 cuffed endotracheal tube secured at the
Normal cuff pressure 23 cm mark at the lips. The cuff pressure was maintained at 35 cm H O to prevent
is between 27 and 40 cm 2
H 2 O, lower for patients with air leak around the cuff. The volume-controlled ventilation settings were: SIMV
hypotension. frequency 10/min, V 800 mL, F O 100%, no PEEP, peak flow 45 L/min, and
I
2
T
sensitivity 22 cm H O. Her initial static compliance was 74 mL/cm H O. Breath
2
2
sounds were equal bilaterally with fine inspiratory crackles in both lower lobes.
Initial blood gases after initiation of mechanical ventilation showed:
pH 7.45
PaCO 2 36 mm Hg
PaO 2 102 mm Hg
The PaO 2 is above SaO 97%
normal and the F I O 2 should be 2 -
reduced. HCO 24 mEq/L
3
Mode SIMV
f 10/min
V T 800 mL
F O 2 100%
I
PEEP 0 cm H O
2
Peak Flow 45 L/min
Sensitivity 22 cm H O
2
C ST 74 mL/cm H O
2
Patient Monitoring

The major monitoring tools used during her recovery were pulse oximetry, end-
tidal CO monitor, and central venous pressure (CVP). Her SpO was 96%. The
SpO 2 (96%) correlates 2 2
well with the SaO 2 (97%). P CO was about 33 to 35 mm Hg (normal 2 mm Hg below PaCO ), and her CVP
2
2
ET
was consistently between 10 and 12 mm Hg (normal 1 to 7 mm Hg).

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