Mechanical Ventilation Cases Study

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Questions and Answers

In Case 2, what action should be taken to return the PaCO2 levels to normal?

Decrease the respiratory rate (RR) to 12 breaths/min.

What is the necessary inspiratory flow to achieve the given settings in Case 1?

The necessary inspiratory flow is 3571 L/min.

What ventilator change is appropriate for the patient in Case 3 with hyperoxemia?

The FiO2 should be decreased to 0.38.

What is the tidal volume set for the patient in Case 2 on SIMV-VC mode?

The tidal volume is set at 500 ml. Signup and view all the answers

What is the PEEP setting for the patient in Case 2?

The PEEP setting is 5 cmH2O. Signup and view all the answers

Identify the primary problem indicated by the ABG results in Case 2.

The primary problem is respiratory alkalosis. Signup and view all the answers

For the patient in Case 1, what is the set breathing rate?

The set breathing rate is 12 breaths/min. Signup and view all the answers

What would be the consequences of hyperoxemia as shown in Case 3?

Hyperoxemia can lead to oxygen toxicity and various complications. Signup and view all the answers

What is the primary goal when managing a patient with respiratory alkalosis as indicated in the first case?

To return the PaCO2 levels to normal. Signup and view all the answers

How should you adjust the mechanical ventilation settings for the patient with bilateral pneumonia experiencing mild hypoxemia?

Increase PEEP by 2-3 cmH2O. Signup and view all the answers

In the case of the comatose patient with a head injury, what would be the most appropriate action regarding FiO2?

No change or decrease FiO2 slightly. Signup and view all the answers

For the adult patient with a PIP of 41 and Pplat of 33, what should be monitored to prevent complications?

Risk of hemodynamic instability and pneumothorax. Signup and view all the answers

What vent settings should be modified for a patient to achieve desired PaCO2 while on AC-VC mode?

Decrease the minute ventilation to adjust and achieve desired PaCO2. Signup and view all the answers

When is it appropriate to use pressure control ventilation in patients with severe respiratory conditions?

When the patient requires a specific pressure to avoid barotrauma. Signup and view all the answers

In mechanically ventilated patients, why is monitoring blood gas values vital?

To assess the effectiveness of ventilation and the patient's oxygenation status. Signup and view all the answers

What does a PaO2 of 65 indicate in the context of mechanical ventilation?

It indicates mild hypoxemia. Signup and view all the answers

Study Notes

Case 1 Ventilatory Settings

Patient ventilated with AC-VC, VT 1000 ml, Set Rate = 12 breaths/min, I:E Ratio = 1:2 in constant flow waveform
Inspiratory flow necessary to achieve settings is 35.71 L/min

Case 2 Patient with Bilateral Pneumonia

65-kg IBW man with bilateral pneumonia
Ventilated on SIMV-VC mode
VT=500 ml, SIMV rate= 16
No spontaneous breaths.
FiO2=0.40, PEEP = 5
ABG results: pH 7.49, PaCO2 30, PaO2 85
Action: Decrease RR to 12 breaths/min to achieve desired PaCO2

Case 3 Hyperoxemia

Patient mechanically ventilated with AC-VC, VT 600, set Rate 12, FiO2 0.65, PEEP 10.
ABG: pH 7.41, PaCO2 38, PaO2 156
Action: Decrease FiO2 to 0.38 to achieve desired PaO2

Case 4 Respiratory Alkalosis

55-kg IBW adult patient ventilated on SIMV-PC mode
Set P = 30 cmH2O, exhaled V₁= 660 ml, Rate=12, no spontaneous efforts.
ABG results: pH=7.55, PaCO2=28, PaO2=87 on FiO2 of 0.45
Action: Decrease VT to 462 to achieve desired PaCO2

Case 5 Mild Hypoxemia

Adult patient with bilateral pneumonia ventilated on AC-VC mode
V₁= 500 ml, Rate=14, FiO2 0.60, PEEP 6 cmH2O
ABG results: pH=7.41, PaCO2=44, HCO3=25, PaO2=65
Action: Increase PEEP 2-3 cmH2O

Case 6 Closed Head Injury

Comatose and apneic patient with closed head injury mechanically ventilated on AC-VC mode
VT= 600 ml (8 ml/kg), set Rate=10, no spontaneous efforts.
ABG results: pH=7.39, PaCO2=40, PaO2=108 on FiO2 of 0.30
Action: No change or decrease FiO2 slightly

Case 7 Respiratory Acidosis and Hypoxemia

Adult patient (60 kg IBW) ventilated on AC-VC mode
VT=500 ml, set rate=17, PEEP=12
Measured PIP= 41, Pplat = 33
ABG results: pH=7.31, PaCO2=51, PaO2 54, HCO3=22, FiO2=0.60
Action: Change to AC-PC mode, set appropriate PIP until VT 500ml thereby Pplat. 230, increase RR to 21, increase PEEP 2-3 cmH2O

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Description

This quiz covers various clinical cases involving mechanical ventilation settings and adjustments. You will analyze scenarios such as acute respiratory conditions, hyperoxemia, and respiratory alkalosis, determining the appropriate ventilatory changes needed for patient care. Test your understanding of ventilation parameters and their impact on ABG results.