Page 681 - Clinical Application of Mechanical Ventilation

Case Studies 647

Mixed Venous
pH 7.36
PvO 2 47 mm Hg
SvO 2 78%
A-aDO 2 462 mm Hg
Qs/QT 42%
Ventilator Settings
Mode PC-IRV
T I 0.82 sec
I:E ratio 2:1
f 24/min
PIP 30 cm H O
2
F O 2 100%
I
PEEP 15 cm H O
2
The patient remained on a 2:1 I:E ratio, and other ventilator settings were ad-
Ventilator settings justed to normalize ventilation and oxygenation. To maintain a PaO greater than
should be adjusted based on 2
the patient’s ventilation and 65 mm Hg (SpO . 90%), the required settings were: peak inspiratory pressure
2
oxygenation requirement, 30 cm H O, PEEP 18 cm H O, and F O 70%.
as well as on the patient’s 2 2 I 2
hemodynamic status.
Patient Management

For the next 14 days, the patient was monitored closely for adverse signs while
in a drug-induced coma. She was placed on a proprofol (Diprivan®) drip to
manage her pain and was given narcotic medications to limit her movements
while on pressure-controlled ventilation. Vigorous pulmonary toilet was begun
Aggressive pulmonary and she was suctioned with a closed directional-tip catheter to the main-stem
hygiene is important in
managing patients who bronchi. This produced a large amount of thick, yellow secretions. She also
are intubated and receiving received frequent acetylcystine (Mucomyst) lavage every 4 hours and was con-
prolonged mechanical
ventilation. fined to a Rotorest® bed to help prevent pulmonary complications associated
with atelectasis.

NOTE: Clinical use and evaluation of lavage must be carefully considered i.e., see
Pedersen, C. R. (2009). Endotracheal suctioning of the adult intubated patient—what
is the evidence? Intensive and Critical Care Nursing, 25(1), 21–30. Ackerman, M. H.
(1993). The effect of saline lavage prior to suctioning. Journal of Critical Care, 2(4),
326–330.

Key Medications

She was given nebulizer treatments with 0.5 mL of 0.5% albuterol sulfate
(Proventil®) and 0.5 mg ipratropium bromide (Atrovent®) every 4 hours for
wheezing. Broad-spectrum antibiotics including a fourth-generation cephalo-
sporin were used to treat ventilator-associated pneumonia (VAP) from long-
term ventilation.

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