Page 665 - Clinical Application of Mechanical Ventilation

Case Studies 631

Mode SIMV
f 10
V T 500 mL
F O 2 60%
I
Pressure Support 15 cm H O
2
Weaning parameters were done each morning to include frequency, minute volume,
tidal volume, vital capacity, maximum inspiratory pressure, and RSBI (f/V ). Wean-
T
ing criteria were done beginning the second day following admission (f 5 22/min,
V 5 9.6 L, V 5 340 mL, VC 5 1.5 L, MIP 5 235 cm H O, f/V 5 64/min/L).
T
T
E
2
All data suggested that her ventilatory effort was adequate and she was weaned off the
ventilator. Subsequent testing showed minor neurologic deficits.
She was alert and oriented to time and place but functioned without memory of
the accident. She appeared comfortable, cooperative, able to follow commands, and
was not diaphoretic or febrile. She was not anxious and was breathing spontane-
ously on CPAP with 10 cm H O of pressure support at a frequency of 14/min. Vital
2
signs and oxygenation results included HR of 88/min, BP of 112/78 mm Hg, SpO
2
of 96% on 35% F O with satisfactory blood gases.
I
2
After satisfactory spontaneous parameters were performed (see above), she was ex-
tubated and placed on a nasal cannula at 3 L/min of O . She was weaned off oxygen
2
and discharged from the hospital 6 days after admission.
Complications

The patient had no apparent pulmonary complications; however, there were minor
neuromotor obstacles to overcome, including the loss of short-term memory and
minimal motor sensory perception to the left. She will undergo physical and oc-
cupational rehabilitation after her release from the hospital.
Reference (hyperventilation to lower ICP):
Dumont, T. M. (2010). Inappropriate pre-hospital ventilation in severe traumatic brain
injury increases in-hospital mortality. Journal of Neurotrauma, 27(7), 1233–1241.

CASE 5: SMOKE INHALATION

INTRODuCTION

Patient history suggests F.H. was a 64-year-old, 76-Kg male admitted to the emergency department from his
potential complications of home where he was found in a smoke-filled room. He was unable to communicate with
burn and smoke inhalation:
infection, bronchospasm, rescuers, appeared confused, and presented with first and second-degree burns over
carbon monoxide (CO), and
cyanide poisoning. 50% of his upper torso. His facial features contained dark smoke and soot about his nose
and mouth, a singed mustache, and he had a strong odor of alcohol on his breath.

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