Page 670 - Clinical Application of Mechanical Ventilation

636 Chapter 19

While the activated charcoal was being administered, the airways and lungs were
Repeat suctioning is lavaged with normal saline and suctioned. This procedure was repeated until the
indicated because watery
brown secretions (stomach return solution became clear.
content) have been suctioned A chest radiograph done later showed that the ET tube was 4 cm above the
from the ET tube.
carina. Hazy infiltrates were noted in both lungs indicating that the patient had
aspirated.
Another blood gas was drawn with the patient intubated and being bagged at a fre-
quency of 20/min. The results were: pH 7.34, PCO 35 mm Hg, PO 350 mm Hg.
2
2
Initial Settings

The patient was transferred to the adult ICU and placed on volume-controlled ventila-
Since aspiration is likely tion. The initial settings were CMV mode, f 20/min, V 720 mL, F O 100%, PEEP
to have occurred, PEEP of T I 2
5 cm H 2 O is used to prevent 5 cm H O, peak flow 60 L/min, and constant flow pattern. With these settings, the
2
atelectasis. peak inspiratory pressure was 25 cm H O, plateau pressure was 20 cm H O, and cor-
2
2
rected V was 710 mL. All alarms were set appropriately. The ABG results on these
T
settings were as follows:
pH 7.32
Alarms should include PaCO 32 mm Hg
low minute volume, low tidal 2
volume, PEEP, high pressure, PaO 2 264 mm Hg
-
low pressure, high frequency, HCO 16 mEq/L
and apnea alarms. 3
SpO 2 98%
Mode CMV
f 20/min
V T 720 mL
F O 2 100%
I
PEEP 5 cm H O
2
PIP 25 cm H O
2
P PLAT 20 cm H O
2

Patient Monitoring

A continuous SpO monitor was placed on the patient with the low alarm set at
2
90%. A good waveform was noted, and the heart rate matched that on the cardiac
Potential complications monitor.
of aspiration may include Respiratory monitoring of the patient consisted of Q2° ventilator checks to in-
aspiration pneumonia and
ARDS. clude the peak inspiratory and plateau pressures, expired tidal volumes, minute vol-
umes, F O , and compliance. Other clinical information and procedures included
I
2
frequency, breath sounds, suctioning, and ET tube cuff pressure.
ARDS is usually Due to the potential complications of aspiration, of particular importance was
preceded by increasing peak the monitoring of high peak and plateau pressure, F O , and PaO . A Swan-Ganz
and plateau pressures (due to I 2 2
decreasing lung compliance), catheter and an arterial line were used to monitor the patient’s hemodynamic status
and increasing F I O 2 require- (i.e., arterial blood pressure, central venous pressure, pulmonary artery pressure,
ment (due to intrapulmonary
shunting). pulmonary capillary wedge pressure, cardiac output, and mixed venous saturation).
Laboratory studies included serum electrolytes.

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