A 75-year-old,5-foot,7-inch female patient with an exacerbation of COPD is placed on the following NIV settings: IPAP = 8 cm H₂O,EPAP = 4 cm H₂O,rate = 12 breaths/min,FɪO₂ = 0.3.The resulting Vᴛ is 255 mL.An arterial blood gas sample is drawn 1 hour later,and the results are: pH = 7.33,PₐCO₂ = 70 mm Hg,PₐO₂ = 58 mm Hg,HCO₃⁻ = 35 mEq/L.What action should the respiratory therapist take at this time?

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Quizplus · Accepted Answer

NIV was initiated at the appropriate settings for this patient; however,the arterial blood gas values show that the patient still has hypercapnia in addition to her chronic ventilatory failure.The current settings are yielding a Vᴛ of 4 mL/kg.The IPAP needs to be increased to maintain the exhaled Vᴛ at 5-7 mL/kg.This will decrease the PₐCO₂ to an acceptable DIF for this patient.

A 75-Year-Old,5-Foot,7-Inch Female Patient with an Exacerbation of COPD Is