med 610 clinical respiratory diseases & critcare med

Mechanical Ventilation

Case 8

At 11:00PM, you are called to the bedside of a 55 year-old man who was intubated one day prior for airway protection during a large upper gastrointestinal hemorrhage due to esophageal varices. He has self-extubated and is lying with the endotracheal tube in his hand. At the time this happened, he had been on an FIO2 of 0.4 and a PEEP of 5 cm H2O. His PaO2 earlier in the day was 100 mm Hg. The team had been planning to do a spontaneous breathing trial in the morning. At present, his oxygen saturation is 94% on 6L oxygen by nasal cannula. The nurse wants to know if you want to re-intubate him.

What should you do?


You decide not to reintubate the patient because his clinical status appears stable. Four hours later, you are called back to the bedside because the patient is laboring to breathe and his oxygen saturation has fallen into the upper 80% range on a venturi mask set with an FIO2 of 0.5. You obtain an ABG and it shows pH 7.30, PCO2 47, PO2 60 and bicarbonate 25.

Should you reintubate the patient or can you give him a trial of non-invasive ventilation?


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