A patient with an IBW of 68 kg is intubated and being mechanically ventilated with VC-CMV,f = 12/min,and Vᴛ = 470 mL.The patient has a combined respiratory rate of 25/min.The ABG results are: pH 7.56,PₐCO₂ 26 mm Hg,and HCO₃⁻ 22 mEq/L.The most appropriate action is to do which of the following?
A) Decrease the set f to 8/min.
B) Decrease the set Vᴛ to 300 mL.
C) Sedate and paralyze the patient.
D) Change the mode to VC-IMV.

Question

Quizplus · Accepted Answer

The patient has ventilator-induced respiratory alkalosis,because the patient is triggering the machine breaths each time there is a spontaneous effort.Decreasing the set f will not alter the rate at which the patient is assisting.Decreasing the set Vᴛ to 300 mL will most likely result in the patient's breathing at a faster rate because of the low volume.The patient could be sedated and paralyzed.However,the patient is not demonstrating a need for this option (i.e.,extreme agitation,increased WOB,and patient-ventilator asynchrony).Changing to the VC-SIMV mode will allow the patient to breathe spontaneously and not trigger a machine breath each time.

A Patient with an IBW of 68 Kg Is Intubated