Page 691 - Clinical Application of Mechanical Ventilation

Case Studies 657

© Cengage Learning 2014

2
1

Figure 19-6 Myathensia gravis. Aspiration of barium on the left side (1) is seen. The right
hemidiaphragm is flat with a poorly defined costophrenic angle (2). This condition may be caused by
pleural effusion.
Initial Settings

The patient was initially placed on volume-controlled ventilation with the following
Glasgow coma score of settings: CMV 16/min, V 750 mL, F O 80%, PEEP 0 cm H O. The patient had
#8 indicates severe brain in- T I 2 2
jury or neurological deficit. A the following ABG results:
score of 15 rules out presence
of neurological deficit. pH 7.47
PaCO 2 43 mm Hg
PaO 2 168 mm Hg
The chest radiograph SaO 97%
shows aspiration of barium in 2
-
the left lower lobe. HCO 30.5 mEq/L
3
Mode CMV
f 16/min
V 750 mL
PaO 2 168 mm Hg is too T
high and the F I O 2 should be F O 2 80%
I
decreased. PEEP 0 cm H O
2
Patient Management

(Day 1) The patient was continued on mechanical ventilation and the F O was
I
2
weaned to 40%, with the following results:
pH 7.58
PaCO 2 21 mm Hg
PaCO 2 21 mm Hg is too PaO 122 mm Hg
low and the CMV frequency 2
should be decreased. SaO 2 96%
-
HCO 19.1 mEq/L
3
Mode CMV

Copyright 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
Editorial review has deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.