A surgeon orders lung expansion therapy for an obtunded 68-year-old, 170-lb man who has de-veloped atelectasis after thoracic surgery
On baseline assessment, the patient cannot perform an IC or VC maneuver, but has no evidence of retained secretions. Which of the following would you recommend?
a. Intermittent positive-pressure breathing (IPPB) at 6 to 8 breaths/min at 10 to 15 ml/kg
b. Continuous positive airway pressure ther-apy at 12 cm H2O for 24 hr
c. Positive end expiratory pressure therapy with bronchodilator and bronchial hygiene
d. Incentive spirometry 10 times an hour at an initial volume of 600 to 800 ml
ANS: A
If either the VC or IC is less than these threshold levels, IPPB is initiated, with the pressure gradually manipulated from the initial setting to deliver at least 15 ml/kg.
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