Pulmonary Disorders I

Patient Cases (continued)

after outside hospital admission for hypoxic respiratory failure. She had been treated for ARDS at the outside

hospital for 3 days before her family requested hospital transfer. On admission, the patient is receiving MV

with the following settings: SIMV mode, tidal volume 600 mL (12 mL/kg), respiratory rate 12 breaths/minute,

PS 10 cm H2O, and PEEP 10 cm H2O. Which is the best therapy for her ARDS?

5 cm H2O; supine positioning.

5 cm H2O; prone positioning; cisatracurium administration.

5 cm H2O; supine positioning; cisatracurium administration.

5 cm H2O; prone positioning.

3. A 63-year-old woman (height 165 cm; total body weight 64 kg) with a medical history of insulin-dependent

diabetes and chronic kidney disease was admitted to the general ward 2 days ago for acute COVID-19 pneu-

monia requiring oxygen therapy via nasal cannula. She was started on dexamethasone 6 mg oral daily. Today,

she transferred to the intensive care unit following endotracheal intubation because of worsening oxygenation

and meeting severe ARDS criteria. Lung-protective MV is initiated at tidal volume 340 mL, respiratory rate

22 breaths/minute, PEEP 12 cm H2O, and Fio2 100%. Her arterial blood gas values are as follows: pH 7.28,

Paco2 46 mm Hg, Pao2 60 mm Hg, and HCO3 24 mEq/L with Sao2 of 92%. Which is most appropriate thera-

peutic plan regarding her corticosteroids?

4. K.J. is a 56-year-old man (height 72 inches; total body weight 120 kg) admitted to the ICU for septic shock

requiring vasoactive support and ARDS pneumonia. Lung-protective MV is initiated as follows: tidal volume

600 mL, respiratory rate 24 breaths/minute, PEEP 14 cm H2O, and Fio2 100% with plateau pressure of 24

mm Hg. His arterial blood gas values are pH 7.28, Paco2 46 mm Hg, Pao2 62 mm Hg, and HCO3 24 mEq/L.

Which of the following treatment strategies may be most appropriate at this time to improve oxygenation?

5. D.J. is a 49-year-old man with septic shock requiring vasoactive support and ARDS with MV at the following

settings: tidal volume 400 mL, respiratory rate 26 breaths/minute, PEEP 20 cm H2O, and Fio2 100%, result-

ing in a plateau pressure of 40 mm Hg. The patient’s arterial blood gas values after mechanical ventilation

initiation are as follows: pH 7.45, Paco2 34 mm Hg, Pao2 110 mm Hg, and HCO3 24 mmol/L with Sao2 88%.

Which of the following strategies is most appropriate at this time?