virgola82
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A 60 yo woman weighing 60 kg is intubated for severe respiratory distress due to obstructive lung disease. She is sedated and the ventilator is set to assist/control mode at a rate of 20/min, Tidal Volume 600 ml, PEEP 5 cm and FiO2 0.4. The inspiratory-to-expiratory ratio is 1:2. Over the course of 15 min she develops progressive tachycardia and hypotension. HR is 120, BP 90/50. A CXR shows hyperinflation, clear lung fields and no pneumothorax. ABG show a PaO2 90, PaCO2 50 and pH 7.38. Which one of the following is the most appropriate intervention.
A. Begin Dopamine
B. Decrease the respiratory rate
C. Incresae the tidal volume
D. Decrease PEEP
E. Decrease sedation
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| prasannakumar
Forum Senior
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D
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| tanmaynator
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d????
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| cirus
Forum Guru
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D is the only one that makes sense, but can anyone explain the pathology..
I was thinking about hyper ventillation..but really don know
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| virgola82
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That's why i posted, I also picked D but it's wrong and actually once I read why it's pretty clear. Because of the COPD that causes obstruction this patient is having air trapping, also named "dynamic hyperinflation" or "intrinsic PEEP". This happens when there is too little time to allow complete exhalation of a breath before the next breath is delivered. This results in lugs hyperinflation -> increased intrathoracic pressure -> decreased BP. So the only way to lengthen expiratory phase in the given scenario is to reduce the resp rate.
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| sailing boat
Forum Elite
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no the ans should be decreas the respiratory rate
cause peep of 5 is normal, upto 10 peep can be given normally to the patient, as he is developing hypotension due to decrease c.o then the patients respiratory rate should be decreased, as it is high, normal is around 14, and his is 20
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| sailing boat
Forum Elite
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so the ans should be B
rr of 20 is high, normal is around 14
peep of 5 is norma, upto 10 can be safely given to a patient
hence decreasing the rr is the best choice here
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| cirus
Forum Guru
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That was my first thaught but when I saw Insp:Expir ratio 2 to one, I excluded it as I thaught that it would help the lund deflate..
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| Justice
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B. Decrease the respiratory rate
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| dr in trouble
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B 
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| elitoki
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B
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