A 46-year-old male patient (IBW = 85 kg) who was injured in a motor vehicle crash has been re-ceiving invasive mechanical ventilation for 24 hours
The patient is awake, alert, and looks comfortable on the following settings: VC-IMV with pres-sure support of 5 cm H2O; set rate = 8 breaths/min; set VT = 500 mL; FIO2 = 0.4; PEEP = 5 cm H2O. A 10-minute spontaneous breathing trial (SBT) yields this information: f = 30 breaths/min, RSBI = 145, P0.1 = 10 cm H2O. What should the respiratory therapist suggest to the physician during patient rounds?
a. Sedate the patient and place him on VC-CMV.
b. Continue with the current ventilator set-tings.
c. Switch to PC-CMV with a rate of 14 breaths/min.
d. Decrease the mandatory SIMV rate to 4 breaths/min.
ANS: B
The RSBI is at a level that suggests the patient is not ready for weaning. An RSBI below 105 suggests that weaning is likely to be successful. The P0.1 is a measurement of the drive to breathe. The patient achieved 10 cm H2O, which indicates a high drive to breathe and suggests that weaning from mechanical ventilation is not likely to succeed. This information is a strong indica-tor that the patient should not begin active weaning at this time and should be continued on the original settings, because the patient was comfortable on those settings.
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