A mechanically ventilated patient is receiving 6 ml/kg tidal volume. At the same time, the patient's Pplateau is 40 cm H2O. Which of the following ventilator adjustments should the therapist make at this time?
A. Reduce the tidal volume to 5 ml/kg.
B. Increase the inspiratory flow.
C. Raise the upper pressure limit.
D. Lengthen the expiratory time.
ANS: A
A. Correct response: No clinical trials of the magnitude of the ARDSnet study have been performed on patients with obstructive airways disease. Nonetheless, because of the presence of regional disparity in the degree of airflow obstruction, and because the concept behind lung protective strategies is to protect the more normal and healthier lung units from ventilator-induced lung injury (VILI), ventilating patients with respiratory failure from airflow obstruction in the same manner as patients in the ARDSnet trial seems reasonable. One particular adjustment is to decrease the delivered tidal volume from 6 ml/kg to 5 ml/kg because of the elevated Pplateau, which is 40 cm H2O.
B. Incorrect response: See explanation A.
C. Incorrect response: See explanation A.
D. Incorrect response: See explanation A.?
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