A 58-Year-Old Man with a History of Chronic Obstructive Pulmonary

question 89

Multiple Choice

A 58-year-old man with a history of chronic obstructive pulmonary disease develops acute respiratory distress syndrome secondary to community-acquired pneumonia.  He has been stable on mechanical ventilation with peak and plateau pressures <30 cm H₂O, and his oxygen requirements have decreased over the past 2 days.
On his third day in the intensive care unit, he is ventilated on assist control mode, with a respiratory rate of 16/min, positive end-expiratory pressure of 10 cm H₂O, and FiO₂ of 0.6 (60%) .  The patient's peak pressure ventilator alarm has been on for the past 10 minutes and his respirations appear more labored.  Pulse has increased from 85 to 120/min, and respiratory rate has increased from 16 to 32/min.  The peak pressure is 44 cm H₂O and the plateau pressure is 24 cm H₂O.  On chest auscultation, breath sounds are coarse and mildly decreased on the left side.
Which of the following actions would be most likely to improve the patient's current symptoms?

• A)Airway suctioning
• B)Albuterol nebulizer treatment
• C)Increase in sedation
• D)Intravenous furosemide
• E)Needle decompression of the left chest

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