A patient is extubated and placed on a cool, bland aerosol with 30% oxygen. Twenty minutes post extubation, the respiratory therapist is called to assess the patient, who has shortness of breath
The respiratory therapist observes intercostal retractions, accessory muscle use, and a respiratory rate of 38 breaths/min. Stridor can be heard without a stethoscope, and the SpO2 has dropped from 97% to 85%. The patient is given an aerosolized racemic epinephrine treatment and reas-sessed. Accessory muscle use continues, intercostal retractions decrease slightly, and stridor is heard on auscultation. The patient's respiratory rate is 30 breaths/min and the SpO2 is 88%. What should the respiratory therapist recommend?
a. Reintubation and mechanical ventilation
b. Heliox therapy and steroid administration
c. Increase the FIO2 on the cool bland aerosol to 40%
d. Use a nonrebreather mask with 15 L/min oxygen.
ANS: B
The racemic epinephrine treatment improved the patient's clinical status, as evidenced by a de-crease in intercostal retractions, decrease in respiratory rate, and increase in SpO2. The patient's stridor now is heard only on auscultation, whereas it was audible without a stethoscope before the racemic epinephrine. Heliox therapy would reduce the patient's WOB further and allow time for the steroids to take effect. Because the patient improved, reintubation would only increase the risk of nosocomial pneumonia and is not warranted at this time. Increasing the FIO2 may help improve the patient's SpO2, but it does not address the patient's upper airway obstruction. A nonrebreather mask with 15 L/min oxygen would not help relieve the patient's upper airway ob-struction.
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