A 68-year-old,5-foot,10-inch male patient with acute-on-chronic respiratory failure due to COPD has been placed on NIV with these settings: IPAP = 8 cm H₂O,EPAP = 4 cm H₂O,FɪO₂ = 0.28.The patient's measured exhaled volume is 350 mL with a spontaneous respiratory rate of 24 breaths/min.The resulting arterial blood gas values are: pH = 7.27,PₐCO₂ = 77 mm Hg,PₐO₂ = 64 mm Hg,SₐO₂ = 88%,HCO₃⁻ = 36 mEq/L.What action should the respiratory therapist take at this time?

Question

Quizplus · Accepted Answer

This patient has an acute-on-chronic respiratory acidosis that has not been corrected by the NIV at the current settings.The resulting Vᴛ is 4.7 mL/kg,which is not enough to reduce the PₐCO₂ to an acceptable DIF for this patient (the pH should be about 7.37).Titrating the IPAP DIF to maintain an exhaled Vᴛ of 5-7 mL/kg can be accomplished by increasing the IPAP.

A 68-Year-Old,5-Foot,10-Inch Male Patient with Acute-On-Chronic Respiratory Failure Due to COPD