A 3-month-old, 6.4-kg infant with ARDS is receiving ventilatory support. The initial settings are: PC-CMV, PIP = 22 cm H2O, PEEP = 5 cm H2O, rate = 30 breaths/min, FIO2 = 0.6. The ABG results show a PaO2 of 48 mm Hg
The respiratory therapist increases the PEEP to 8 cm H2O. The pressure-volume loops below show the change that occurs after this increase. (Loop A [solid line] was generated from the ini-tial settings. Loop B [dashed line] was generated from the increase in PEEP.) The respiratory therapist's most appropriate action is which of the following?
a. Decrease the PEEP to 5 cm H2O.
b. Keep the PEEP at 8 cm H2O.
c. Decrease the PIP to 20 cm H2O.
d. Increase the PIP to 24 cm H2O.
ANS: B
The increase in PEEP to 8 cm H2O has led to an immediate rise in volume for the set pressure. According to the infant's weight, the volume should be 32 mL. The increase in PEEP has brought the volume to that level without overdistention; this means that the PEEP of 8 cm H2O is appropriate and should be maintained. Obtaining an ABG reading at this point would be ap-propriate.
You might also like to view...
Jamie, a 10-year-old child, is recovering from a case of late-stage Lyme disease and requires IV ceftriaxone
Jamie's pediatrician supervises and coordinates medical team conferences by phone with the epidemiologist, home health nurse, and school nurse to ensure that Jamie's education will not be adversely effected by her extended absence from school. Over the course of the month during which Jamie has received the IV ceftriaxone, more than 40 minutes have been spent in reviewing records, coordinating, and implementing Jamie's healthcare plan. Which of the following best reflects the service(s) provided? a. Case management services: medical team conference without direct contact with patient b. Care plan oversight services c. Domiciliary, rest home, or home care plan oversight services d. Office or outpatient services, established patient, level 4
Two thirds of children born with Down syndrome have:
A. diabetes mellitus. B. intracranial bleeding. C. unilateral paralysis. D. congenital heart disease.