Page 692 - Clinical Application of Mechanical Ventilation

658 Chapter 19

f 16/min
V T 750 mL
F O 2 40%
I
PEEP 0 cm H O
2
The patient’s set frequency was decreased to 12/min and the blood gas results
were:
pH 7.53
PaCO 2 25 mm Hg
PaCO 2 25 mm Hg is still PaO 128 mm Hg
too low and the frequency 2
should be decreased again. SaO 2 97%
-
HCO 20 mEq/L
3
Mode CMV
F 12
V T 750 mL
The pressure support F O 40%
level should be titrated until I 2
a desired spontaneous tidal PEEP 0 cm H O
2
volume is obtained.
The CMV frequency was further decreased to 8/min for the rest of Day 1.
(Day 2) The next morning the patient was on CMV of 8/min, V 750 mL, F O
T
2
I
40%, and no PEEP. He had the following spontaneous parameters: V 9.7 L, V
E
T
660 mL, f 15/min, MIP 224 cm H O, and VC of 2,080 mL. The patient was alert
2
and responsive. A CPAP/pressure support (CPAP/PS) trial was done with CPAP of 5
cm H O and PS of 5 cm H O, base flow of 2 L/min, and an F O of 40%. The patient
2
2
I
2
tolerated these settings for 4 hours with spontaneous tidal volumes of 600 to 700 mL
and a spontaneous frequency of 16 to 21/min. Breath sounds showed fine inspiratory
crackles throughout the anterior bases. All vital signs were within normal limits.
(Day 3) The patient was placed on CMV to rest overnight. Spontaneous param-
eters were: V 7.8 L, V 720 mL, frequency 12/min, MIP 212 cm H O, and a vital
E
2
T
capacity of 4,020 mL. Heart rate, blood pressure, and temperature were all within
3
normal limits. The patient’s WBC spiked at a high of 16.2 3 10 (normal 3.2 to 9.8 3
The increased WBC may 10 ), a chest radiograph showed the endotracheal tube was in proper position, and
3
be due to aspiration of barium
and subsequent aspiration the bilateral opacities were consistent with barium aspiration.
pneumonitis. He tolerated the previous CPAP/PS settings for 4 hours and was taken off CPAP/
PS when he began to show extreme accessory muscle use. Blood gases during spon-
taneous breathing revealed:
pH 7.38
PaCO 2 34 mm Hg PaCO 34 mm Hg
indicates hyperventilation. 2
Prolonged hyperventilation PaO 2 87 mm Hg
may lead to fatigue of respira-
tory muscles. SaO 2 97%
Mode Spontaneous
F O 2 40%
I
(Day 4) The patient was rested overnight on CMV, and spontaneous parame-
ters were: V 9.9 L, V 550 mL, f 18/min, MIP 226 cm H O, and VC of 3 L.
T
2
E

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