A 45-year-old female (58-kg IBW) with a past medical history of asthma arrives at the emergen-cy department short of breath, anxious, diaphoretic, and unable to perform a peak expiratory flow measurement
She also has a combined acidosis. Breath sounds reveal the patient is not moving much air. The patient is intubated, stabilized, and transported to the ICU. The ventilator settings are: PC-CMV, f = 12/min, PIP = 30 cm H2O, FIO2 = 0.6, and PEEP = 3 cm H2O. The patient is sedated and paralyzed; the resulting ABGs are: pH 7.17, PaCO2 69.3 mm Hg, PaO2 90 mm Hg, and HCO3? 21 mEq/L after continuous bronchodilator therapy. The respiratory rate is increased to 20/min, and the next ABG results are: pH 7.26, PaCO2 58 mm Hg, PaO2 96 mm Hg, and HCO3? 22 mEq/L. The respiratory therapist should suggest which of the following at this time?
a. Increase PIP to 38 cm H2O.
b. Decrease PIP to 25 cm H2O.
c. Continue with current therapy.
d. Change to VC-CMV, f = 12/min, VT = 700 mL.
ANS: C
The current therapy should be continued in an effort to prevent lung injury.
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