Page 707 - Clinical Application of Mechanical Ventilation

Case Studies 673

Indications

Continuous positive airway pressure (CPAP) was administered via a T-piece resus-
citator to support the infant’s respiratory effort. After stabilization in the delivery
room, the infant was admitted to newborn intensive care unit (NICU) for further
observation, evaluation, and treatment with antibiotics. The infant was placed on a
heated/humidified head box at 40% oxygen. Within a few hours after admission,
she became dusky and presented with moderate to severe intercostal and substernal
retractions. As her condition continued to deteriorate, an umbilical artery catheter
(UAC) and an orogastric (OG) tube were placed, and CPAP at 5 cm H 0 via nasal
2
prongs on an F O of 60% was initiated.
I
2
pH 7.28
PaCO 2 48 mm Hg
PaO 2 40 mm Hg
-
HCO 22 mEq/L
3
B.E. 22 mEq/L
Hct 41%
Mode CPAP at 5 cm H 0
2
via nasal prongs
F O 2 60%
I
In spite of CPAP and 60% oxygen, the infant’s oxygenation status continued to
deteriorate. Her respiratory frequency increased as she tried to compensate for the
hypoxia. Capillary refill time was increased from 4 to 5 sec. Her extremities were
Increased capillary refill cold and the mean arterial pressure was 35 mm Hg.
time indicates shunting of
blood flow from the extremi- Based on the condition and prognosis of this infant, she was electively intubated
ties or increased peripheral with a 3.5 mm endotracheal (ET) tube and placed on SIMV via a time-cycled
vascular resistance.
pressure-limited ventilator.
Initial Settings

The predicted tidal volume (V ) was estimated by using a 4- to 6 mL/Kg range.
T
At a weight of 3.8Kg, the estimated V range is 15.2–22.8 mL. The initial settings
T
of the time-cycled pressure-limited ventilator were: SIMV, f 40/min, PIP/PEEP
24/5 cm H O, T INSP 0.5 sec, and F O 100%. At these settings, the mean airway
2
2
I
pressure (mPaw) was 14.5 cm H O, V was 13.3 mL, and blood gases from a UAC
T
2
sample showed:
pH 7.32
PaCO 2 44 mm Hg
PaO 2 43 mm Hg
-
HCO 22.2 mEq/L
3
B.E. 22.9 mEq/L
Mode SIMV
PIP/PEEP 24/5 cm H O
2
f 40/min
T INSP 0.5 sec

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