Which of the following would suggest that a patient is ready to ...

[JMatthes]

Which of the following would suggest that a patient is ready to be weaned from a ventilator?
 
  a. Vital capacity (VC) of 8 mL/kg ideal body weight (IBW)
  b. PaO2 or 65 mm Hg on and FIO2 of 0.6
  c. Dead space-to-tidal volume ratio (VD/VT) of 0.75
  d. Rapid shallow breathing index of 75 breaths/min/L

Question 2

A patient is extubated and placed on a cool, bland aerosol with 30 oxygen. Twenty minutes post extubation, the respiratory therapist is called to assess the patient, who has shortness of breath.
 
  The respiratory therapist observes intercostal retractions, accessory muscle use, and a respiratory rate of 38 breaths/min. Stridor can be heard without a stethoscope, and the SpO2 has dropped from 97 to 85. The patient is given an aerosolized racemic epinephrine treatment and reas-sessed. Accessory muscle use continues, intercostal retractions decrease slightly, and stridor is heard on auscultation. The patient's respiratory rate is 30 breaths/min and the SpO2 is 88. What should the respiratory therapist recommend?
  a. Reintubation and mechanical ventilation
  b. Heliox therapy and steroid administration
  c. Increase the FIO2 on the cool bland aerosol to 40
  d. Use a nonrebreather mask with 15 L/min oxygen.

[mfedorka]

Answer to Question 1

ANS: D
The RSBI is the most frequently studied and one of the more reliable tests for determining a pa-tient's weaning status. It is calculated by dividing the respiratory frequency (in breaths/min) by the VT (in L): f/VT. This measurement is taken 1 minute after disconnecting the spontaneously breathing patient from the ventilator and oxygen. Successful weaning is more likely if the RSBI is less than 105 (normal range, 60-105). Values above 105 suggest that a patient is not ready for weaning and probably will fail a weaning trial.

Answer to Question 2

ANS: B
The racemic epinephrine treatment improved the patient's clinical status, as evidenced by a de-crease in intercostal retractions, decrease in respiratory rate, and increase in SpO2. The patient's stridor now is heard only on auscultation, whereas it was audible without a stethoscope before the racemic epinephrine. Heliox therapy would reduce the patient's WOB further and allow time for the steroids to take effect. Because the patient improved, reintubation would only increase the risk of nosocomial pneumonia and is not warranted at this time. Increasing the FIO2 may help improve the patient's SpO2, but it does not address the patient's upper airway obstruction. A nonrebreather mask with 15 L/min oxygen would not help relieve the patient's upper airway ob-struction.

[JMatthes]

Thank you

[mfedorka]

No problemo