A 3-month-old, 6.4-kg infant with ARDS is receiving ventilatory support. The initial settings are: PC-CMV, PIP = 22 cm H2O, PEEP = 5 cm H2O, rate = 30 breaths/min, FIO2 = 0.6. The ABG results show a PaO2 of 48 mm Hg
The respiratory therapist increases the PEEP to 8 cm H2O. The pressure-volume loops below show the change that occurs after this increase. (Loop A [solid line] was generated from the ini-tial settings. Loop B [dashed line] was generated from the increase in PEEP.) The respiratory therapist's most appropriate action is which of the following?
a. Decrease the PEEP to 5 cm H2O.
b. Keep the PEEP at 8 cm H2O.
c. Decrease the PIP to 20 cm H2O.
d. Increase the PIP to 24 cm H2O.
ANS: B
The increase in PEEP to 8 cm H2O has led to an immediate rise in volume for the set pressure. According to the infant's weight, the volume should be 32 mL. The increase in PEEP has brought the volume to that level without overdistention; this means that the PEEP of 8 cm H2O is appropriate and should be maintained. Obtaining an ABG reading at this point would be ap-propriate.
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