med 610 clinical respiratory diseases & critcare med

SOM 4th Yr Curriculum

Mechanical Ventilation

Case 4

A 63 year-old woman was intubated four days ago for respiratory failure secondary to sepsis from a presumed pneumonia. She is on appropriate antibiotics, is now off pressors, and her WBC count has declined to the normal range. During your pre-rounding, you note that her F_IO₂ is down to 0.4 and she is on a PEEP of 5 cm H₂O. On these settings, the ABG shows pH 7.36, pCO₂ 46, PO₂ 75, HCO₃- 26. She has a weak cough and continues with copious secretions, requiring suctioning every 30 to 60 minutes.

At what point do you start considering whether your patient is ready to come off the ventilator?

How do you determine if the patient is capable of being separated from the ventilator?

Suppose your patient demonstrates that she can be separated from the ventilator. Should she be extubated?

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SOM 4th Yr Curriculum CLERKSHIP INFORMATION Introduction / Goals and Objectives Rotations HMC UWMC VAMC Seminars Faculty Only PULMONARY EDUCATION Pulmonary Med Library Arterial Blood Gases Cardiopulmonary Exercise Testing Mechanical Ventilation Pulmonary Function Testing Pleural Effusion Radiology	Mechanical Ventilation Case 4 A 63 year-old woman was intubated four days ago for respiratory failure secondary to sepsis from a presumed pneumonia. She is on appropriate antibiotics, is now off pressors, and her WBC count has declined to the normal range. During your pre-rounding, you note that her F_IO₂ is down to 0.4 and she is on a PEEP of 5 cm H₂O. On these settings, the ABG shows pH 7.36, pCO₂ 46, PO₂ 75, HCO₃- 26. She has a weak cough and continues with copious secretions, requiring suctioning every 30 to 60 minutes. At what point do you start considering whether your patient is ready to come off the ventilator? How do you determine if the patient is capable of being separated from the ventilator? Suppose your patient demonstrates that she can be separated from the ventilator. Should she be extubated? Return to Case Index \| Go to Case 4 answers Top of Page
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