A postoperative patient, still under anesthesia, is being ...

[MGLQZ]

A postoperative patient, still under anesthesia, is being ventilated with VC-CMV with automode. After 2 hours, the patient is waking up and beginning to breathe spontaneously. The ventilator will respond by ___________________ __.
 
  a. switching to the pressure support mode
  b. switching to the volume support mode
  c. delivering time-triggered, pressure-limited breaths
  d. ensuring minimum mandatory minute ven-tilation

Question 2

A 46-year-old male patient (IBW = 85 kg) who was injured in a motor vehicle crash has been re-ceiving invasive mechanical ventilation for 24 hours.
 
  The patient is awake, alert, and looks comfortable on the following settings: VC-IMV with pres-sure support of 5 cm H2O; set rate = 8 breaths/min; set VT = 500 mL; FIO2 = 0.4; PEEP = 5 cm H2O. A 10-minute spontaneous breathing trial (SBT) yields this information: f = 30 breaths/min, RSBI = 145, P0.1 = 10 cm H2O. What should the respiratory therapist suggest to the physician during patient rounds?
  a. Sedate the patient and place him on VC-CMV.
  b. Continue with the current ventilator set-tings.
  c. Switch to PC-CMV with a rate of 14 breaths/min.
  d. Decrease the mandatory SIMV rate to 4 breaths/min.

[mmj22343]

Answer to Question 1

ANS: B
If a postoperative patient is still recovering from the effects of anesthesia and the ventilator op-erator has selected volume-controlled continuous mandatory ventilation (VC-CMV) with auto-mode as the operating mode, all breaths are mandatory (time triggered, volume limited, and time cycled). If the patient begins to trigger breaths, the ventilator switches to VS (patient triggered, pressure limited, and flow cycled with a volume target) and remains in this mode as long as the patient is breathing spontaneously.

Answer to Question 2

ANS: B
The RSBI is at a level that suggests the patient is not ready for weaning. An RSBI below 105 suggests that weaning is likely to be successful. The P0.1 is a measurement of the drive to breathe. The patient achieved 10 cm H2O, which indicates a high drive to breathe and suggests that weaning from mechanical ventilation is not likely to succeed. This information is a strong indica-tor that the patient should not begin active weaning at this time and should be continued on the original settings, because the patient was comfortable on those settings.

[MGLQZ]

Gracias!

[scottmt]

Excellent