A patient is receiving ventilation with volume-controlled continuous mandatory ventilation (VC-CMV). During a patient-ventilator system check the respiratory therapist sees the flow-volume loop below
The most appropriate action is to do which of the following?
a. Add positive end-expiratory pressure (PEEP).
b. Switch to pressure-controlled continuous mandatory ventilation (PC-CMV).
c. Administer a bronchodilator.
d. Check the endotracheal (ET) tube cuff pressure.
ANS: C
The flow-volume loop shown in this question reflects increasing airway resistance. The expiratory flow part of the loop shows the scooped-out appearance. This is typical of a patient with airway obstruction. Administration of a bronchodilator will help to relieve some of the airway obstruc-tion due to bronchospasm. Since the problem is obstructive and not restrictive, adding positive end-expiratory pressure (PEEP) or switching to pressure-controlled continuous mandatory venti-lation (PC-CMV) will not address the issue. The flow-volume loop shows no leak in the system.
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