Page 668 - Clinical Application of Mechanical Ventilation

634 Chapter 19

Patient Monitoring

Careful observation should be carried out to assess any evidence of pulmonary
HBO with 100% O 2 at complications such as thermal injuries to the airway or pulmonary edema. These
3 atm raises the dissolved
oxygen to about 6 vol% - an injuries may also increase the incidence and severity of ARDS as a complication to
amount that is sufficient to mechanical ventilation. Impaired gas exchange and/or hypoxia caused by increased
sustain cerebral metabolism.
levels of CO may be treated with PEEP or hyperbaric oxygen therapy (HBO) if CO
poisoning is severe. The patient’s mental functions should be monitored to prevent
CO-induced anoxic brain syndrome.

Patient Management

The patient was closely monitored for 2 days while on mechanical ventilation for
evidence of further injuries (i.e., decreasing lung compliance or evidence of ARDS,
thermal airway injuries, and tissue hypoxia).

Key Medications

The patient was given Proventil® MDI treatments with 10 puffs inline through the
ventilator circuit and continued with medication nebulizer treatments with Proventil®
solution after extubation for wheezing.

Weaning

The swelling to the airway was significantly reduced by day 2 in the unit, and the
Reduction of wheezing, patient was weaned and extubated after the return of adequate ventilation. His
improvement of breath
sounds, and work of breath- spontaneous frequency was 16/min, and he had adequate oxygenation and pulmo-
ing are signs that the swelling nary mechanics. He was immediately given an aerosol treatment of 0.5 mL racemic
to the airway has improved.
epinephrine (Micronephrine®) in distilled water, to minimize stridor and reduce
edema of the upper airway. Blood gases after extubation revealed the following:
pH 7.42
PaCO 2 38 mm Hg
PaO 2 104 mm Hg
-
HCO 23.6 mEq/L
3
HbCO 2.8 g %
Hb 14.1 g %
CaO 2 18.8 vol %
SaO 2 96%
Mode Cool aerosol mask
f (spontaneous) 16/min
F O 2 28%
I
The patient remained in the hospital for three more days where he was weaned
from the oxygen and required fewer medication nebulizer treatments to control his
intermittent wheezing.

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