Page 705 - Clinical Application of Mechanical Ventilation

Case Studies 671

in 2.0 mL of saline Q 4 hours for wheezing, inline with the ventilator circuit. This
medication was discontinued after her removal from the ventilator.
Weaning

Beginning on the 10th day of mechanical ventilation, the patient began CPAP trials.
She tolerated this procedure well for up to 8 to 10 hours at a time. She was then returned
to SIMV mode with a backup frequency of 6/min, tidal volume of 400 mL (approx.
8 mL/Kg), PEEP of 5 cm H O, F O of 30%, and pressure support (PS) of 10 cm H O
2
I
2
2
to rest for the night. Her frequency remained in the mid to high 20s and her return vol-
ume was consistently between 350 mL and 450 mL. She did not complain of shortness
of breath, difficulty of breathing, or chest discomfort, and appeared to rest comfortably.
By the 12th day of continuous mechanical ventilation, the patient was able to tolerate
CPAP of 5 cm H O and F O of 30% 24 hours/day. Her ABGs revealed the following:
I
2
2
pH 7.44
PaCO 2 46 mm Hg
PaO 2 91 mm Hg
SaO 2 96%
-
HCO 29.9 mEq/L
3
Mode CPAP
Spont f 28/min
F O 2 30%
I
PEEP 5 cm H O
2
At that point, she was removed from the ventilator and placed on a humidified T-
piece (Briggs “T” adaptor) at an F O of 30%. She was monitored via a continuous-
I
2
pulse oximeter that revealed SpO between 92% and 94%. Her frequency remained
2
in the low 20s. She was closely observed for signs of respiratory distress or tachypnea
(.30/min). Three days later, ABGs again were obtained while on the T- piece at an
F O of 30%. These revealed:
2
I
pH 7.46
PaCO 2 45 mm Hg
PaO 2 87 mm Hg
SaO 2 96%
-
HCO 30.9 mEq/L
3
f 24/min
On the 14th day, her tracheostomy was buttoned and she was placed on a nasal
cannula at 2 L/min without complications. She was decannulated two days later.
Complications

The patient showed no serious and lasting complications from this episode of botu-
lism and was discharged from the hospital on room air 21 days following her ad-
mission. She did exhibit some generalized weakness and mild ptosis that continued
to improve after discharge.

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.