Page 663 - Clinical Application of Mechanical Ventilation

Case Studies 629

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Figure 19-2 Head injury. The chest radiograph is normal. The small round markings (1 and 2)
are the pulmonary blood vessel running parallel to the roentgen ray (X-ray).

not require surgical intervention. Radiographs of her spine were unremarkable and
there was no evidence of spleen or liver injury. The chest radiograph was also normal
A CT scan of the head and
radiographs of the spine and (Figure 19-2). She was transported to the ICU in critical condition and placed on
major organs are indicated for a mechanical ventilator due to her extensive head injuries and a therapeutic drug-
head trauma patients.
induced coma was initiated.
Initial Settings

Since heavy sedation and short-term, mild hyperventilation were desired (PaCO
2
In head injury, the lungs 34 to 35 mm Hg), the initial ventilator settings on volume-controlled ventilation
are not affected unless there
are coexisting complications consisted of assist/control (A/C) mode at a frequency of 14/min, V of 500 mL
T
(e.g., flail chest, aspiration). (approx. 10 mL/Kg), F O of 60%, and no PEEP.
2
I
Patient Monitoring
Drug-induced coma is
done to reduce metabolic rate The initial blood gas analysis after 20 minutes of mechanical ventilation showed:
and minimize intracranial
pressure (ICP).
pH 7.30
PaCO 2 29 mm Hg
PaO 2 256 mm Hg
-
HCO 13.9 mEq/L
3
Hb 11 gm %
Mode A/C
f 14
V T 500 mL
F O 2 60%
I
PEEP 0 cm H O
An ICP of less than 2
10 mm Hg is the desirable
target for this patient. The patient was closely monitored. Continuous intracranial pressure (ICP) ranged
from 6 to 8 mm Hg. Arterial and pulmonary artery catheters showed a heart rate of

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