The level of PEEP that is most appropriate for a patient with the information shown below is which of the following?
Time 0725 0730 0742 0748 0755 0800
PEEP (cm H2O) 5 8 10 12 15 18
Cs (mL/cm H2O) 27 28 34 29 29 25
P(a-et)CO2 (mm Hg) 8.8 6.2 4.8 4.9 6.5 10
PaO2/FIO2 159 190 237 237 221 204
a. 8 cm H2O
b. 10 cm H2O
c. 12 cm H2O
d. 15 cm H2O
ANS: B
At a PEEP of 10 cm H2O, the static compliance is at its highest level (34 mL/cm H2O), and the arterial to end-tidal CO2 tension gradient is at its lowest (4.8 mm Hg). This means that at a PEEP of 10 cm H2O, this patient's FRC has been restored and the effectiveness of ventilation has been optimized. With PEEP higher than 10 cm H2O, these values show that the alveoli are being over-stretched. The PaO2/FIO2 is also at its highest level of 237.
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