A patient's transairway pressure (PTA) is rising while the plateau pressure (Pplateau) remains un-changed. The treatment plan that could correct this problem includes which of the following?

Question

1. Administer a bronchodilator.
2. Insert a chest tube.
3. Measure unintended positive end-expiratory pressure (auto-PEEP).
4. Suction airway secretions.
a. 2 only
b. 2 and 4 only
c. 1 and 4 only
d. 1 and 3 only

Answer 1

ANS: C
Airway resistance can be estimated for a ventilated patient using transairway pressure (PTA). When the PTA rises, the airway resistance is rising. When plateau pressure (Pplateau) is constant, this means that the static compliance has not changed. In this question the PTA is rising while the Pplat-eau remains the same. This is due to an increase in Raw and can be corrected by administering a bronchodilator and/or suctioning the airways. An increase in Pplateau could occur from a pneumo-thorax, which would require the insertion of a chest tube and also from dynamic hyperinflation, which can be measured as unintended positive end-expiratory pressure (auto-PEEP).