The respiratory therapist is evaluating the following ventilator flow sheet. The recommendation that is most appropriate in this situation is which of the following?
Time PIP (cm H2O) Pplateau (cm H2O) PEEPE (cm H2O) Exhaled VT (mL) Flow rate (L/min)
0800 35 30 5 1000 60
1000 39 34 5 1000 60
1100 45 39 5 1000 60
1130 50 44 5 1000 60
a. Increase extrinsic positive end-expiratory pressure (PEEPE).
b. Suction the airway.
c. Switch out the heat moisture exchanger (HME).
d. Administer a bronchodilator.
ANS: A
What is demonstrated here is that there is an increase in the plateau pressure (Pplateau) and this re-flects a decreasing lung compliance or stiffening of the lungs. Adding extrinsic positive end-expiratory pressure (PEEPE) to this patient could result in a decrease in the Pplateau. Since the transairway pressure (PTA) has remained stable over the 3.5 hours, there is no increase in airway resistance and no need to suction the airway, switch out the heat moisture exchanger (HME), or administer a bronchodilator.
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