The patient with which of the following assessment findings meets the criteria for beginning weaning from PEEP?
a. PaO2 = 85 mm Hg; FIO2 = 0.6; Cs = 20 mL/cm H2O; PEEP = 12 cm H2O
b. PaO2 = 100 mm Hg; FIO2 = 0.9; Cs = 22 mL/cm H2O; PEEP = 10 cm H2O
c. PaO2 = 150 mm Hg; FIO2 = 0.7; Cs = 25 mL/cm H2O; PEEP = 12 cm H2O
d. PaO2 = 95 mm Hg; FIO2 = 0.3; Cs = 30 mL/cm H2O; PEEP = 15 cm H2O
ANS: D
The criteria for initiation of weaning from PEEP include: (1) an acceptable PaO2 (90 mm Hg) on an FIO2 0.4; (2) hemodynamic stability; (3) absence of sepsis; (4) improved CL (e.g., CS > 25 mL/cm H2O); and (5) PaO2/FIO2 ratio > 250 to 300. Choice "A" does not meet the minimum PaO2 or the minimum FIO2 and has a low Cs. Choice "B" has the appropriate PaO2, but the FIO2 is high and the Cs is low. Choice "C" has a high PaO2, but the FIO2 is 0.7, the calculated PaO2/FIO2 ratio is 214, and the compliance is just at the acceptable level. Choice "D" has all acceptable criteria, including a calculated PaO2/FIO2 ratio of 317.
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