med 610 clinical respiratory diseases & critcare med

Mechanical Ventilation

Case 10

A 57 year-old woman was intubated two weeks ago for respiratory failure resulting from ARDS due to urosepsis. About 5 days ago, her oxygen requirements declined such that she is now on an FIO2 of 0.4 with a PEEP of 5 cm H2O. She has been doing poorly, however, on her spontaneous breathing trials and has not been able to be separated from the ventilator. On her latest spontaneous breathing trial this morning, her tidal volumes were between 125 and 150 ml and her respiratory rates rose to 35 after only 10 minutes of spontaneous breathing.

What items should you consider on the differential diagnosis for a patient who cannot be liberated from the mechanical ventilator?


What diagnostic steps can you consider to help you sort through this differential?


What can you do to help her get off the ventilator?


At what point do you consider placing a tracheostomy tube in this patient?


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