Asthma Management and Ventilation Quiz

Clinical Case Overview

• Mrs. Shelly Ann Bazen-Atkins, 37 years old, admitted for severe asthma.
• Current weight: 135 lbs (61 Kg), height: 5' 7" (170 cm).
• Orally intubated with a 7.5 mm ID ENT tube and receiving mechanical ventilation.
• Ventilation settings: VC SIMV, VT 450 ml, f 16 breaths/min, FIO2 45%, PEEP 7 cmH2O.

Evaluation Recommendations

• Key assessments to recommend for clinical status include:
  • Appearance: Observe overall condition.
  • Arterial Blood Gas (ABG) report: Critical for oxygenation and ventilation status.
  • Ventilator graphics: Assess patient-ventilator interactions.
  • Chest X-ray report: Rule out lung pathology.
  • Vital signs: Monitor hemodynamic stability.
  • Breath sounds: Check for abnormal lung sounds.

Ventilator Graphics Analysis

• Graphic evaluation indicates Air Trapping/Auto PEEP:
  • Important to recognize in patients with asthma exacerbations.

Recommended Interventions

• Based on assessment findings:
  • Perform in-line MDI treatment with a Short-Acting Beta Agonist (SABA) to relieve bronchospasm and improve airflow.
  • Increase the expiratory time to address Auto PEEP concerns.
  • Utilize a Heliox mixture to reduce PIP below 35 cmH2O, aiding in lung protection strategies.

Intervention Justifications

• Increasing expiratory time helps lower airway resistance and promote better gas exchange.
• Heliox (helium-oxygen mixture) decreases the work of breathing; beneficial in high PIP situations.

Important Clinical Indicators

• Monitor key ventilatory parameters:
  • PIP (Peak Inspiratory Pressure): Should be kept below 35 cmH2O for lung protection.
  • Static compliance: Assess for changes indicating patient condition.
• Use of manual resuscitator should be verified to ensure readiness for emergencies.

Final Recommendations

• Focus on optimizing respiratory therapy and mechanical ventilation settings.
• Regularly reassess treatment efficacy and patient responses to interventions.