Page 714 - Clinical Application of Mechanical Ventilation

680 Chapter 19

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Figure 19-7 Chest radiograph shows cardiomegaly (1); pulmonary vascular congestion
(2); bilateral infiltrates (3).

Hospital Course

During the first 2 days of her hospital stay, F.W. was maintained on continuous
nasal bilevel PAP at 12/6 cm H O with 2 L/min of oxygen. For the CHF and
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related conditions, she was treated with Lasix, Digoxin, and Cardizem. The pulmo-
nologist ordered nebulizer treatments Q 4 hours with 2.5 mg albuterol and 0.5 mg
ipratropium bromide in 3 mL of normal saline to relieve bronchospasm and promote
secretion clearance. Prednisone (steroid) was ordered to decrease airway inflamma-
tion secondary to her asthma. Prophylactic antiobiotics (Biaxin) were administered,
used to address her probable pneumonia since sputum induction was unsuccessful.

NOTE: F.W.’s medical record retrieved shortly after admission indicated that PFTs had been
done 1 year before, and at that time her FEV 1 was 14% of predicted and her D L CO was
21%. Baseline room air blood gases were:

pH 7.38
PaCO 2 67 mm Hg
PaO 2 45 mm Hg
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HCO 38 mEq/L
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