Page 688 - Clinical Application of Mechanical Ventilation

654 Chapter 19

pH 7.43
PaCO 2 48 mm Hg
PaO 2 64 mm Hg
-
HCO 31 mEq/L
3
Hb 11.1 g %
CaO 2 13.9 vol %
SpO 2 91%
Mode A/C
f 24/min
V T 500 mL
F O 2 80%
I
PEEP 8 cm H O
2
The frequency was increased to 30/min to override her excessive and demand-
ing respiratory efforts. PEEP was increased to 10 cm H O, and F O was reduced
2
2
I
to 70%.
Blood gases were drawn 30 min later with the following results:
pH 7.51
PaCO 2 47 mm Hg
PaO 2 59 mm Hg
-
HCO 36.4 mEq/L
3
B.E. 12.4 mEq/L
Hb 9.6 g %
CaO 2 12.4 vol %
SpO 2 91%
Mode A/C
f 30/min
V T 500 mL
F O 2 70%
I
PEEP 10 cm H O
2
Several unsuccessful weaning attempts were made. Over several days she was
weaned to a frequency of 24/min on assist/control (A/C) with a V of 380 mL
T
Low V T is used to mini- (approx. 7 mL/Kg), F O of 50%, and PEEP of 8 cm H O, and she remained on
mize the airway pressures. I 2 2
those settings for nearly one week. Due to her deteriorating condition and persis-
tent complications, the family members and physician decided to remove her from
ventilatory support, and she died a short time later.

Discussion

Through the course of hospitalization, the patient experienced many complicat-
ing injuries which contributed to her failure to recover. These included baro-
trauma to the lung parenchyma (pneumothorax was corrected with a chest
tube), pneumomediastinum, and interstitial emphysema verified through serial

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