Assessment of a mechanically ventilated patient reveals use of accessory muscles and a respira-tory rate of 26 breaths/min. The mode is CPAP with 5 cm H2O and an FIO2 of 0.4. The most ap-propriate action is which of the following?
a. Return the patient to full ventilatory sup-port.
b. Add pressure support to the CPAP.
c. Increase the CPAP to 8 cm H2O.
d. Deflate the cuff of the ET tube.
ANS: B
This patient is suffering from an increased WOB, as evidenced by the use of accessory muscles and elevated respiratory rate. Adding pressure support will decrease the patient's WOB by elim-inating the airway resistance caused by the ET tube. Returning the patient to full ventilatory support before trying pressure support may add time to the patient's length of stay on the venti-lator. Increasing the CPAP is not appropriate, because there is no evidence of hypoxemia. De-flating the cuff would negate the CPAP and also increase the risk of ventilator-associated pneu-monia.
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