A male patient (74-kg IBW) is being ventilated with PC-CMV, f = 12/min, PIP = 20 cm H2O, TI = 1.5 seconds; the resulting flow-time scalar is shown below
The patient's measured VT is 435 mL. ABG results on these settings are: pH 7.32, PaCO2 54 mm Hg, HCO3? 25 mEq/L. The most appropriate action to take is which of the following?
a. Increase f to 16/min.
b. Increase TI to 2.5 sec.
c. Increase PIP to 27 cm H2O.
d. Decrease flow rate to 40 L/min.
ANS: C
The flow-time scalar shows that TI is adequate, because it shows a time of zero flow during in-spiration. Therefore, changing TI would not be appropriate. The measured VT for this patient is at 5.9 mL/kg IBW; therefore, the VT could be increased. In the PC mode, this would be done with by increasing the set PIP using the following formulas:
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