A 65-year-old,73-inch-tall,195 lb male patient was admitted 2 days ago for renal failure.The patient has a history of chronic obstructive pulmonary disease (COPD)and has a pulse of 122 breaths/min,BP 153/88,and temperature 37° C.The patient is intubated for acute-on-chronic respiratory failure with hypoxemia.The physician requests volume-controlled continuous mandatory ventilation (VC-CMV).The initial settings for the ventilator should be which of the following?

Question

Quizplus · Accepted Answer

First calculate ideal body weight (IBW)for a male,using the formula 106 + 6(ht - 60).This patient's IBW is 84 kg.Minute ventilation is about 100 mL/kg IBW,which would be 8.4 L/min.Since the patient has a history of chronic obstructive pulmonary disease (COPD),the tidal volume should be set to between 8 and 10 mL/kg with rates of between 8 and 12 breaths/min.This would make the appropriate tidal volume range 672-840 mL.This eliminates the two choices where the volume is outside of this range,leaving choices "A" and "D." Choice "D" can be eliminated because the rate of 15 is outside the suggested rates for COPD patients.Rapid rates will lead to air trapping in patients with high airway resistance.

A 65-Year-Old,73-Inch-Tall,195 Lb Male Patient Was Admitted 2 Days Ago