Page 679 - Clinical Application of Mechanical Ventilation

Case Studies 645

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Figure 19-5 Chest trauma. Rib fracture is noted on the right side (1) of this chest radiograph.
Infiltrates of the left side (2) cause a greater density than the right side (3). The diaphragm shadow
on the left is lost (4) likely due to pulmonary contusion or possible aspiration pneumonitis. Left-
sided atelectasis pulls the mediastinum and trachea (5) to the left. The shift does not appear to be
significant, possibly due to patient rotation when radiograph was taken.

Indications

Due to the extent of her injuries, she was hemodynamically stabilized with a trans-
Chest trauma, and fusion of four units of blood. A short-acting neuromuscular blocker (Succinylcho-
unstable and worsen-
ing cardiopulmonary and line) was used to facilitate intubation with a size 8.0 endotracheal tube. She was
hemodynamic status are subsequently transferred to the intensive care unit (ICU) in critical but stable con-
the primary indications for
mechanical ventilation. dition requiring mechanical ventilation.

Initial Settings

She was immediately placed on volume-controlled ventilation on assist/control at
A PaCO 2 of 25 mm Hg
shows alveolar hyperventila- 15/min V 600 mL (approx. 10 mL/Kg), F O 60%, and PEEP 5 cm H O. Chest
T
I
2
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tion, suggesting ventilatory tubes were placed to evacuate the pleural space of blood and air. Her initial blood
insufficiency (i.e., hyperventi-
lation to maintain a PaO 2 of 83 gases after 10 minutes on the ventilator were:
mm Hg) on 60% F I O 2 .
pH 7.46
PaCO 2 25 mm Hg
PaO 2 83 mm Hg
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HCO 17.3 mEq/L
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Hb 13.7 g %
Mode A/C
Prolonged hyperventila- f 15/min
tion leads to patient fatigue V 600 mL
and deterioration of ventila- T
tion and oxygenation status. F O 2 60%
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PEEP 5 cm H O
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