Which setting on a ventilator would require a nursing intervention to improve the outcome for a 60 kg patient with acute lung injury (ALI)?
1. FiO2 = 0.30 or 30%
2. Tidal volume (VT) = 900 mL
3. Respiratory rate = 15 per minute, when the CO2 levels are elevated
4. Inspiratory: Expiratory ratio (I:E) = 1:2
2
Rationale 1: The patient with ALI needs supplemental oxygen to help maintain PaO2.
Rationale 2: VT is the volume of gas delivered in one ventilatory cycle. VT is normally 7 mL/kg of body weight or around 500 mL. In mechanical ventilation, the volume is kept at 5–8 mL/kg in order to prevent trauma to lung tissues. In ALI, lower volumes are preferred. The nurse would need to discuss reducing the tidal volume with members of the multidisciplinary team.
Rationale 3: No action is needed by the nurse. The rate is increased to allow the blow off of CO2; therefore, a rate 15 per minute is adequate for the patient with ALI.
Rationale 4: It would not benefit the patient to alter the I:E ration while the tidal volume for this patient is excessive.
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