At 1030 the respiratory therapist is called to the bedside of a patient being mechanically venti-lated with VC-IMV

The patient is a 55-kg female who has been intubated with a size 8 endotracheal tube. Currently, the ET tube is located 20 cm at the gum line. During spontaneous breathing, the patient shows lack of coordinated chest wall movement, and the respiratory therapist notes some retraction of the intercostal spaces. The respiratory therapist performs a system check. The current and past few patient-ventilator system checks reveal the following information:
Time 0430 0640 0835 1030
PIP (cm H2O) 28 31 34 41
Pplateau (cm H2O) 18 21 19 20
The most appropriate action to take in this situation is which of the following?
a. Deflate the cuff and reposition the endo-tracheal tube.
b. Request that the patient receive haloperi-dol and midazolam.
c. Administer albuterol via an in-line me-tered-dose inhaler.
d. Switch the mode to PC-IMV and increase the rate.

ANS: C
The lack of coordinated chest wall movement, the intercostal retractions, and the increased transairway pressure (seen at 1030) indicate bronchospasm. This can be confirmed by auscultat-ing the patient's chest. The patient should be suctioned before receiving the bronchodilator to remove any mucus. The sudden onset rules out an insidious increase in mucus. The ET tube is properly placed at the 20-cm mark and therefore does not require repositioning. This patient is not displaying any evidence of agitation, delirium, or anxiety; therefore, administration of haloperidol and midazolam is not appropriate in this situation. There is also no evidence of a need to change from volume to pressure control or to increase the set rate at this time.