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A 176 lb male patient is intubated and receiving volume control A/C ventilation. His settings are as follows: 40% FiO2 at a rate of 12/min and a VT of 550 mL. A blood gas was drawn and bedside measurements displays the following results:
Which of the following actions would be appropriate at this time?
- Place the patient on a 40% T-tube and monitor closely
- Switch the patient to SIMV at a rate of 5/minute
- Place the patient on 5 cm H2O CPAP and monitor closely
- Maintain the current ventilator settings and re-evaluate later
Medicine
To get this one right, you must be able to interpret the patient’s ABG results and make the appropriate changes to the ventilator settings, or recommend the best course of action for the patient. These are the types of questions that you will see on the TMC Exam.
The first thing you should note is that the ABG results are all within the normal ranges. Then you can look at the bedside measurements.
The fast spontaneous rate, low spontaneous tidal volume, low vital capacity, and low MIP/NIF all indicate that the patient is not ready for a spontaneous breathing trial and should not yet be weaned. So in this case, you should maintain the current setting and re-evaluate the patient at a later time.
So since all of the other answer choices demonstrate a type of weaning, we know that the correct answer has to be D.
The correct answer is: D. Maintain the current ventilator settings and reevaluate later
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