Author Question: A physician is using a pressure support protocol to wean a patient off ventilatory support. The ... (Read 60 times)

jayhills49 · **on:** Jul 16, 2018

A physician is using a pressure support protocol to wean a patient off ventilatory support. The patient is now at a 5 cm H2O pressure level and has a spontaneous respiratory rate of 21/min.

Other cardiovascular and respiratory signs indicate that the patient remains stable. Which of the following actions would you recommend at this point?
a. Switch the patient to 5 cm H2O continu-ous positive airway pressure (CPAP) through the endotracheal tube.
b. Extubate the patient and provide supple-mental O2.
c. Switch the patient to intermittent manda-tory ventilation at a rate of 2/min.
d. Decrease the pressure support level to 3 cm H2O.

Question 2

An alert patient receiving ventilatory support through a demand flow intermittent mandatory ventilation system exhibits clinical signs of an increased work of breathing whenever you try to decrease the mandatory rate below 6/min.

In order to aid in weaning this patient, which of the following would you recommend?
a. Apply a low level of pressure support.
b. Apply a high level of inspiratory pressure.
c. Increase the mandatory VT.
d. Decrease the mandatory VT.

scikid · **Reply #1 on:** Jul 16, 2018

Answer to Question 1

ANS: B
In general, patients who can spontaneously breathe comfortably at this level of pressure support can be extubated without problems.

Answer to Question 2

ANS: A
With intermittent mandatory ventilation, the addition of pressure support can overcome the work of breathing imposed during spontaneous breaths because of the presence of endotracheal and tracheostomy tubes, demand-flow systems, and ventilator circuits.