A patient is being ventilated with a PEEP of 10 cm H2O and an FIO2 of 0.4
The arterial blood gas results show that the patient remains hypoxemic, and the respiratory thera-pist increases the PEEP to 18 cm H2O, maintaining the FIO2 at 0.4. The patient's static compli-ance changes from 28 to 22 mL/cm H2O just after this change. The respiratory therapist should do which of the following?
a. Decrease PEEP to 10 cm H2O and in-crease the FIO2 to 0.6.
b. Decrease PEEP to 15 cm H2O and meas-ure static compliance.
c. Keep PEEP at 18 cm H2O and increase the FIO2 to 0.6.
d. Increase PEEP to 20 cm H2O and measure static compliance.
ANS: B
The increase in PEEP from 10 to 18 cm H2O caused overdistention of the gas exchange units. This is evidenced by the decrease in compliance from 28 to 22 mL/cm H2O. PEEP should be in-creased in increments of 3-5 cm H2O at a time. Therefore, the respiratory therapist should step the PEEP back to 13-15 cm H2O and check the static compliance.
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