Pressure Controlled/Inverse Ratio Ventilation and Airway Pressure Release Ventilation A patient was admitted in respiratory distress. Her history included a flu-like illness that progressively got...

Pressure Controlled/Inverse Ratio Ventilation and Airway Pressure Release Ventilation

A patient was admitted in respiratory distress. Her history included a flu-like illness that progressively got worse, necessitating a trip to the emergency room (ER). Her chest radiograph showed bilateral diffuse infiltrates in a honeycomb pattern consistent with ARDS. Once intubated, she was placed on assist-control at a rate of 22/min and Vt of 500 mL. Her plateau pressure was very high (60 cm H 20) and she required an Fio2 of 1.0 and 10 cm H 20 of PEEP. ABGs on these settings were pH 7.23, Paco2 38 mm Hg, and Pao2 52 mm Hg. She was agitated, thrashing, and asynchronous with the ventilator, despite a sensitivity setting of -1 cm H20, a short inspiratory time, and a high ventilator rate. The decision was made to sedate and paralyze the patient and place her on PC/IRV mode. Settings were:

After 1 day of these ventilator settings, the team felt it would be best to stop the paralytic agents and decrease the sedation to allow for spontaneous breathing but still provide a high level of lung recruitment. Once the patient was awake and breathing spontaneously, the team switched the mode to APRV.

Are the pH of 7 .34 and Paco2 of 55 obtained after changing the 1ettings to PC/IVR appropriate for thi1 patient?

1he team would lib to deCRUC the patients C0₂
onAPRV. What maneuftf would be the nat mp?