A 70-year-old, 61-inch-tall female patient was admitted with an acute exacerbation of chronic obstructive pulmonary disease (COPD)

Question

After 12 hours of oxygen therapy, bronchodilator therapy, and intravenous corticosteroids, the patient began to show signs of clinical deterioration. Her chest X-ray revealed an enlarged heart and bilateral infiltrates. Her arterial blood gas shows acute on chronic respiratory failure. It is de-cided that this patient requires intubation and mechanical ventilation. The most appropriate ven-tilator settings for this patient include which of the following?
a. Volume-controlled continuous mandatory ventilation (VC-CMV) rate 15, VT 200 mL, FIO2 1.0, positive end-expiratory pressure (PEEP) 5 cm H2O
b. VC-CMV rate 12, VT 400 mL, FIO2 0.4, PEEP 3 cm H2O
c. Pressure-controlled intermittent mandato-ry ventilation (PC-IMV) rate 10, peak in-spiratory pressure (PIP) 30 cm H2O, FIO2 0.60, PEEP 3 cm H2O
d. PC-IMV rate 12, PIP 35 cm H2O, FIO2 0.30, PEEP 8 cm H2O

Answer 1

ANS: B
The tidal volume setting for patients with chronic obstructive pulmonary disease (COPD) should be 5-8 mL/kg with a rate of 8-16 breaths/min. Positive end-expiratory pressure (PEEP) should be less than or equal to 5 cm H2O. The ideal body weight (IBW) for this patient is 50 kg. Therefore, her tidal volume (VT) setting should be between 250 and 400 mL. Fractional inspired oxygen (FIO2) should be <0.50 with a PEEP of 3-5 cm H2O. The only answer that fits these criteria is "B."