A patient with a past medical history of COPD was placed on a ventilator after upper abdominal surgery for a serious wound infection

Although the patient was medically stable, a tracheostomy was performed 2 weeks later because the patient was unable to be weaned from the ventilator. The patient is on VC-CMV, rate = 12, VT = 700 mL, FIO2 = 40%, PEEP = 5 cm H2O, with an HME. The respiratory therapist notes that the patient is assisting at a rate of 18 and has bilaterally decreased breath sounds in the bases. The respiratory therapist suctions a moderate amount of very thick, tenacious yellow sputum from the tracheostomy tube. What action should the respiratory therapist take?
a. The HME should be replaced with an active heated humidifier system.
b. No action is necessary, because there seems to be no patient problem.
c. The patient should be suctioned on a regular schedule instead of when needed.
d. PEEP and the FIO2 should be increased, and diuretic and positive inotropic agents should be administered.

ANS: A
This patient seems to have a secretion problem, as evidenced by the very thick, tenacious yellow sputum suctioned from the ET tube. The thickness of the sputum indicates drying of the secre-tions. To alleviate this problem, the HME should be replaced with a heated humidification sys-tem.