Question

A 62-year-old woman is receiving ventilatory support with volume ventilation. She had abdominal surgery 10 hours ago. She has no history of smoking. Over the past few hours, the following patient information was gathered.

Time 0700 0900 1000

Volume 450 mL 450 mL 450 mL

PIP 18 cm H2O 24 cm H2O 27 cm H2O

Pplateau 13 cm H2O 12 cm H2O 14 cm H2O

1.       What is the most likely cause of the increase in PIP between 7 and 10 am?

2.       List some of the problems that can cause this type of increase in PIP.

3.       What actions should the respiratory therapist take to determine the source of this patient’s problem

Answer 1

1. The airway resistance increases with a positive pressure of water which directly increases peak inspiratory pressure. The positive pressure of water increases with time, so that PIP increases at 10 am compared to 7 am.

2. Problems that cause an increase in PIP:

• Increased secretions
• Bronchospasm
• Barotrauma
• Decreased Lung compliance
• Increased mean airway pressure
• Pneumothorax
• Decreased cardiac output

3.

• The respiratory therapist should involve in positive outcomes of the patient.
• Monitor the pressure readings PIP, Fio2 carefully.
• Identify the cause of PIP and maintain peak pressure.
• The respiratory therapist should follow the protocol in the prevention of ventillation associated pneumonia.
• Use of advanced technology more effectively and safely.
• Control of pressure volumes in ventilation.
• Encourage for early ambulation.