A 75-year-old,5-foot,7-inch female patient with an exacerbation of COPD is placed on the following NPPV settings: IPAP = 8 cm H₂O,EPAP = 4 cm H₂O,rate = 12 breaths/min,F_IO₂ = 0.3.The resulting V_T 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

NPPV 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 V_T of 4 mL/kg.The IPAP needs to be increased to maintain the exhaled V_T at 5 to 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