The RT performs a patient-ventilator system check on a 24-year-old, 5-foot, 10-inch male patient who has been intubated because of a drug overdose

The RT notices what appears to be swelling around the patient's upper anterior chest and neck area. Palpation elicits a tissue paper feeling. The ventilator settings are: VC-CMV, rate 12/min with no patient assist, VT 900 mL, PEEP 5 cm H2O, FIO2 0.4, TI 1.2 sec. The most appropriate action for the RT to take is which of the following?
a. Increase the set flow rate.
b. Decrease the set tidal volume.
c. Reduce the set respiratory rate.
d. Perform emergency needle decompression.

ANS: B
Assessment of this patient reveals that he has subcutaneous emphysema, as evidenced by the swelling around the upper anterior chest and neck area and the tissue paper feeling on palpation. This is a form of barotrauma caused by alveolar rupture as a result of too much volume. The PEEP setting is only 5 cm H2O, which is physiologic. The VT setting, however, is too high. The IBW for this patient is 75 kg; 900 ÷ 75 = a set volume of 12 mL/kg. This needs to be adjusted to 8-10 mL/kg. The subcutaneous emphysema should subside on its own.