A female intubated patient has been weaned from full ventilatory ...

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A female intubated patient has been weaned from full ventilatory support to PSV 5 cm H2O, CPAP 5 cm H2O, and an FIO2 of 0.3. The patient is alert and oriented and doing well. The res-piratory therapist performs a cuff leak test.
 
  The average peritubular leak is 70 mL. The respiratory therapist should recommend which of the following?
  a. Maintain the patient on the current set-tings and redo the cuff leak test in 24 hours.
  b. Increase the PSV to 10 cm H2O and maintain the CPAP and FIO2.
  c. Extubate the patient and place her on a heated aerosol generator with an FIO2 of 0.4.
  d. Pretreat the patient with steroids and/or racemic epinephrine before extubation.

Question 2

The mode of ventilation that maintains a minimum VE by increasing or decreasing the amount of support (VT or respiratory rate) given to the patient is ___________________ .
 
  a. volume support
  b. automatic tube compensation
  c. mandatory minute ventilation
  d. adaptive support ventilation

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Answer to Question 1

ANS: D
This patient is at high risk for developing stridor after extubation. Pretreatment with either race-mic epinephrine and/or steroids would help reduce this risk. No change in ventilator parameters is called for in this situation. Extubating the patient and putting her on a heated aerosol would in-crease the risk of upper airway inflammation because of the heat. Waiting 24 hours when the pa-tient is ready for extubation increases the patient's risk of ventilator-acquired pneumonia.

Answer to Question 2

ANS: C
In MMV, the ventilator automatically increases the level of support if the patient's spontaneous ventilation decreases, thus maintaining a consistent minimum VE. Patients who regain the ability to breathe spontaneously can increase their own VE, and the machine automatically lowers sup-port without the clinician having to change any specific ventilator settings.