Question

Case Study 22-1 ts A 62-year-old man with a history of chronic obstructive pulmonary disease (coPD) presen to the emergency department (ED) with a chief complaint of worsening shortness o (SOB) over a 2-day history; the SOB came on following a recent upper respiratory infect In the ED, his oxygen saturation is 86% on room air. He is complaining of severe dyspnea, only speaking in short sentences, and appears very fatigued. His vital signs are as follow s: RR: 28 breaths/min HR: 132 beats/min BP: 152/94mm Hg Lung sounds: Diffuse wheezes and a prolonged expiratory phase Arterial blood gas (ABG): Done on room air and shows a pH 7.11; Paco2 77 mm Hg: (HCO3-) 33 mEq/L; and Pa02 61 mm Hg. 1. What are the indications for initiation of mechanical ventilation? The physician asks for suggestions to correct this patient's current respiratory distress. What would you suggest? 2. What do you think about the possibility of using noninvasive ventilation (NIV) for this patient? 3.

Answer 1

1) The strong indicators for mechanical ventilation are

• Acute primary respiratory acidosis
• hypoxemia
• Tachypnea, Tachycardia
• COPD
• ABG value

2)The following can be suggested like

• Oxygen administration
• Surfactant replacement theraoh
• Corticosteroids
• vapotherm
• CPAP
• supportive therapy

3)Some of the possibility for using Non invasive ventilation for this patient are

• Old age
• Associated disease condition like COPD
• To avoid endotracheal incubation
• Used in acute respiratory distress ir failure