Which condition may result from excessive PEEP like affects in the lungs when using Vapotherm (HFNC)

A 60 year old 90kg (198 lb.) man is admitted to the ICU following smoke inhalation.  The RR is 28/min and the patient is on a NRM.   ABG’s are as follows:   pH 7.58, paC02 22torr, pa02 90 torr, HC03 22 meq/L, Base Excess -2.  What is your recommendation?

A neonatal patient receiving HFOV is on the following settings:  12 Hz, MAP 8cmH20, Amplitude 16cmH20, fi02 50%.  How can you tell if the amplitude is the correct setting?

A patient on NAVA has an Edi signal of 13.6, an Edi min of 0.6 cmH20, a NAVA level of 1.2and a PEEP of 5 cmH20. What amount of pressure support + PEEP are they receiving?

A patient is intubated in the ICU for airway management post intracranial hemorrhage.    Ventilator settings are PRVC rate of 18/min, VT 600ml, fi02 .30, PEEP 5 cmH20.  The patient’s IBW is 75 kg.   ΔP is 22 cmH20.   Abg’s on these settings:  sp02 97%, pH 7.58, paC02 22torr, pa02 90 torr, HC03 22 meq/L, Base Excess -2.  What changes would you recommend, if any?

A patient is switched from PRVC to SIMV mode, rate of 10/min, VT 350 ml, fi02 0.40, PEEP 5 cmH20, Pressure Support 8 cmH20,  I-time is 1.0 second in which she had a comfortable work of breathing.  After the switch, here are the ventilator parameters:  PIP 36 cmH20, PPlat 20 cmH20, spon VT 200 ml’s, total RR 35/min, I:E 1:1, Ve 11.5 L.  Patient Assessment:  increased work of breathing with paradoxical respirations noted. Abg’s: pH 7.38, paC02 43 torr, pa02 65 torr,  HC03 22 meq/L, B.E. -What could you attribute this clinical picture to?

Read p.164, Understanding the Structure of the Presentation, in your Textbook.  A well organized presentation has 3 parts: an Introduction, a Body, and a Conclusion.  For your presentations, you will need to use these phrases when introducing information/topics for each of these 3 parts. Match the Useful Phrases for Presenting  on pages 173-174 with the correct part of a presentation.

You suspect a patient is receiving too large of a tidal volume on the ventilator.  What could you check to verify this?

Male patient IBW 70 kg with Guillian Barre Syndrome is trached with a 7.0 mm Trach tube and has been vented for the past 2 weeks.  Current vent settings:  PRVC 12/min, VT 450ml, fi02.28, PEEP 5 cmH20.  PIP 20 cmH20, static pressure is also 20 cmH20.  VE 5.4 L/min.  Total RR 12/min and Abg’s are within normal limits. Weaning parameters were performed with a NIF -15cmH20, VC 500ml, RSBI on CPAP with 5 cmH20 pressure support is 70.  There are no signs of respiratory distress when placed on CPAP:  RR 8/min, VT on pressure support of 5 cmH20 is 350ml.  Abg’s are the following:  pH7.30, paC02 53torr, pa02 78 torr, HC03 24 meq/L. How should you approach liberating this patient from the ventilator?

A patient on a high flow nasal cannula is on a flowrate of 35L/min and an fi02 of 1.0.  The sp02 is 88%.  What changes do you recommend?