A patient in the subacute care unit is receiving NIV with a PTV system, with an IPAP of 10 cm H2O and an EPAP of 3 cm H2O
The patient's latest arterial blood gas values reveal an increase in the PaCO2. The most appropriate action to take is which of the following?
a. Increase the IPAP.
b. Decrease the IPAP.
c. Increase the EPAP and IPAP.
d. Intubate and mechanically ventilate.
ANS: C
The EPAP of 3 cm H2O is not providing enough continuous flow of gas through the system to minimize the rebreathing of CO2. Increasing both the EPAP and IPAP will provide enough flow to wash out the CO2 and keep the pressure support DIF consistent.
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