An Intubated Patient with No Known History of Congestive Heart

question 26

Multiple Choice

An intubated patient with no known history of congestive heart failure is in the ICU.The patient is comatose and currently receiving mechanical ventilation via volume-controlled continuous mandatory ventilation (VC-CMV) ,set rate 12 bpm,set tidal volume (V_T) 400 mL,positive-end-expiratory pressure (PEEP) 18 cm H₂O,fractional inspired oxygen (FIO₂) 0.35,and the patient is not assisting.Hemodynamic measurements show the following: central venous pressure (CVP) 5 mm Hg,pulmonary artery pressure (PAP) 33/20 mm Hg,and pulmonary artery occlusion pressure (PAOP) 16 mm Hg.Arterial blood gas (ABG) results are: pH 7.43,arterial partial pressure of carbon dioxide (P_aCO₂) 38 mm Hg,arterial partial pressure of oxygen (P_aO₂) 90 mm Hg.The physician asks for recommendations to improve this patient's hemodynamics.The most appropriate recommendation for this patient is which of the following?

• A) Initiate pressure support ventilation (PSV)10 cm H₂O with CPAP 10 cm H₂O,and check cardiac output.
• B) Decrease the PEEP incrementally and recheck hemodynamic measurements.
• C) Change to volume-controlled synchronized intermittent mandatory ventilation (VC-SIMV)with the same settings,recheck hemodynamics measurements.
• D) Change to pressure controlled continuous mandatory ventilation (PC-CMV),peak inspiratory pressure (PIP)25 cm H₂O,PEEP 18 cm H₂O,FIO₂ 0.35 and check PAP.

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