A patient seen in the emergency department exhibits paralysis of the lower extremities that is getting progressively worse
Vital capacity is 6 mL/kg, maximum inspiratory pressure (MIP) is ?17 cm H2O, and oxygen sat-uration measured by pulse oximeter (SpO2) is 89%. Arterial blood gases are pending. The physi-cian suspects Guillain-Barré syndrome. The most appropriate action at this time is which of the following?
a. Intubate and mechanically ventilate.
b. Place patient on a nonrebreather mask.
c. Initiate continuous positive airway pres-sure.
d. Initiate noninvasive positive pressure ven-tilation.
ANS: A
This patient's maximum inspiratory rate (MIP) and vital capacity (VC) measurements are both critical. Since the patient has a progressive neuromuscular disease with these critical values and a below normal pulse oximetry reading, this patient should be intubated and mechanically venti-lated before the patient develops an acute situation. Placing the patient on a nonrebreather mask or initiating continuous positive airway pressure (CPAP) will not address the fact that the neu-romuscular disease is now beginning to affect this patient's ventilator muscle strength. Since protection of the airway may become an issue, invasive ventilation would be the most appropriate action.
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