A patient, who is nasally intubated, due to facial surgery, has been successful on her spontaneous breathing trial
She currently has moderate hypoxemia, despite a fractional inspired oxygen (FIO2) of 40% and positive end-expiratory pressure (PEEP) of 5 cm H2O while on volume-controlled continuous mandatory ventilation (VC-CMV). The most appropriate ventilator mode for this patient is which of the following?
a. Airway pressure release ventilation (APRV)
b. Continuous positive airway pressure (CPAP)
c. Pressure support ventilation (PSV) with positive end-expiratory pressure (PEEP)
d. Intermittent mandatory ventilation (IMV) with pressure support ventilation (PSV) and positive end-expiratory pressure (PEEP)
ANS: D
The patient is ready to wean and can be placed on intermittent mandatory ventilation (IMV) to allow some ventilator breaths but also allow the patient to breathe spontaneously. The pressure support will help to overcome the increased airway resistance of the small endotracheal tube, due to the nasal intubation. The positive end-expiratory pressure (PEEP) will maintain oxygenation and keep the alveoli open.
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