An intubated patient with chronic obstructive pulmonary disease ...

[cherise1989]

An intubated patient with chronic obstructive pulmonary disease (COPD) is breathing on pres-sure support ventilation (PSV) 13 cm H2O with positive end-expiratory pressure (PEEP) 5 cm H2O and a flow cycle setting of 25.
 
  The pressure-time scalar shown in the figure is evaluated by the respiratory therapist. What action should the respiratory therapist take at this time?
 
  a. The patient and ventilator are synchro-nized and no change should be made.
  b. The inspiratory flow rate should be in-creased to match the patient's needs.
  c. The flow cycle setting should be increased to allow more time for exhalation.
  d. The pressure support setting should be in-creased to match the peak pressure.

Question 2

When changing the control variable from volume control (VC) to pressure control (PC), the initial inspiratory pressure should be set based on which of the following methods?
 
  a. Body surface area multiplied by 4
  b. Plateau pressure measurement taken dur-ing VC ventilation
  c. Maximum peak inspiratory pressure during VC ventilation
  d. Maximum peak inspiratory pressure minus plateau pressure during VC ventilation

[rachel]

Answer to Question 1

ANS: C
The slight rise at the end of inspiration on the pressure-time scalar in the figure shows that the patient is actively exhaling before the flow-cycle criterion is being met. This problem can be avoided by using a higher flow-cycle criterion that will end inspiration sooner and allow for longer expiratory time to decrease air trapping.

Answer to Question 2

ANS: B
Initial pressure is set at the plateau pressure (Pplateau) value during volume-controlled continuous mandatory ventilation (VC-CMV) and must be adjusted as necessary to achieve tidal volume (VT).

[cherise1989]

Thanks for the timely response, appreciate it

[amcvicar]

Excellent