Page 715 - Clinical Application of Mechanical Ventilation

Case Studies 681

On the third day following admission, the pulmonologist attempted to wean F.W.
from bilevel PAP. She was placed on CPAP at 7.5 cm H O and ABGs were drawn
2
an hour later; the results were as follows:
pH 7.16
CPAP alone increases the PaCO 91 mm Hg
work of breathing. Patient 2
requires some mechanical PaO 2 66 mm Hg
assistance via bilevel PAP (i.e., HCO 31 mEq/L
-
IPAP). 3
SaO 2 90%
As a result of her deteriorating blood gas results and clinical condition, F.W. was
placed back on bilevel PAP at 12/6 cm H O for 24 hours. Over the next several
2
days, she was gradually weaned to 1 L/min via nasal cannula during the day and bi-
level PAP at night. The physician discussed several options with F.W. and her family,
and it was decided that upon discharge from the hospital she would use nocturnal
ventilation at home. Her total hospital stay was 11 days.
Home Care Management

Twenty-four hours prior to discharge from the hospital, the case manager contacted
a local home medical equipment provider for respiratory services and a home care
agency for nursing services. Among other health care professionals, this case was
reviewed with the respiratory therapist. Due to the complexity of her pulmonary
condition and special management requirements, the physician decided to directly
communicate with the respiratory therapist from the medical equipment company.
Arterial blood gases on day of discharge were as follows:
pH 7.32
PaCO 2 60 mm Hg
PaO 2 62 mm Hg
-
HCO 30 mEq/L
3
SaO 2 93%
Bilevel PAP 12/6 cm H O
2
Oxygen 1 L/min via nasal cannula during the day and bilevel PAP
therapy at 12/6 cm H O, F O of 24% at night
I
2
2
Orders for Home Equipment
1. 1 L/min via nasal cannula continuously Oxygen concentrator
2. Portable oxygen Conserving device with M-6 cylinders

3. Nebulizer treatments QID Small air compressor
4. Nocturnal bilevel PAP 10/5 cm H O, 24% NPPV with backup frequency of 6/min
2
5. Keep head of bed elevated 30 degrees Hospital bed
6. 1,200-calorie diet

7. Ambulate as tolerated
8. Incentive spirometry TID Incentive spirometer (from hospital)
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