A male patient (83 kg IBW)is intubated and ventilated with PC-CMV,f = 12/min,set PIP = 28 cm H₂O,resulting in a V_T of 430 mL.The ABG results on this setting are: pH 7.35,PaCO₂ 45 mm Hg,and HCO₃^- 23 mEq/L.Forty-eight hours later on the same settings,the ABG results are: pH 7.54,PaCO₂ 27 mm Hg,and HCO₃^- 21 mEq/L with an exhaled V_T of 800 mL.The most appropriate action at this time is which of the following?

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Quizplus · Accepted Answer

At first the patient responded appropriately to the PC-CMV settings.At that point the C_s was 15 mL/cm H₂O.After 48 hours,the patient's lungs improved and the same pressure,28 cm H₂O,resulted in a V_T of 800 mL.The patient's C_s now is 28.5 mL/cm H₂O,and the combination of C_s and PIP is resulting in respiratory alkalosis.The acceptable V_T range for this patient is 415 to 664 mL (5 to 8 mL/kg IBW).Because the exhaled tidal volume now exceeds this range,the volume needs to be reduced.This is accomplished by reducing the set PIP using the following formulas: Desired V_T = 11ea68f7_d69e_2347_b0a4_654bf3461fc9_TB1877_11 and Set PIP = V_T/C_S = 19 cm H₂O.

A Male Patient (83 Kg IBW)is Intubated and Ventilated with PC-CMV,f