A male patient who is 5'10" and weighs 190 lbs arrives at the hospital having suffered a closed head injury in a motor vehicle accident.The patient is unconscious and a computer tomogram of the head reveals an intracranial bleed.The patient receives an intracranial pressure (ICP)monitor following neurosurgery.Initial ventilator settings should include which of the following?

Question

Quizplus · Accepted Answer

The initial settings for a closed head injury patient include pressure-controlled (PC)or volume-controlled (VC)continuous mandatory ventilation (CMV),tidal volumes between 8 to 12 mL/kg,respiratory frequency (f)15 to 20 bpm,positive-end-expiratory pressure (PEEP)0 to 5 cm H₂O with caution and higher only if there is severe hypoxemia,and fractional inspired oxygen (F_IO₂)100% to start and titrate to keep partial pressure of oxygen (P_aO₂)between 70 and 100 mm Hg.This eliminates both synchronized intermittent mandatory ventilation (SIMV)choices.The PC-CMV choice has a peak inspiratory pressure (PIP)and PEEP that are too high for this type of patient because it would increase intracranial pressure (ICP).Choice "A" fits within the guideline for ventilation of the closed head injury patient.

A Male Patient Who Is 5'10" and Weighs 190 Lbs