med 610 clinical respiratory diseases & critcare med

Mechanical Ventilation

Case 7

You are called to the bedside of a patient because the nurse is concerned that the ventilator’s pressure alarm is now going off. He was admitted for a COPD exacerbation and was intubated earlier in the day when he failed a trial of non-invasive ventilation. Earlier in the evening, the peak pressure was 45 cm H2O while the static pressure was 25 cm H2O. At the time she calls you, the peak pressure has risen to 60 cm H20 and the static pressure is now 40 mm Hg. His heart rate has increased from 90 beats/minute to 110 beats/minute while his blood pressure has fallen from 110/85 to 90/70. The physical exam is noteworthy for diminished breath sounds on the left side of the chest.

What do static pressures represent on the ventilator?


What do peak pressures represent on the ventilator?


Where do you think the problem lies with this particular patient?


What management steps should you institute at this point?


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