Respiraeory Failure-Asebma
A 35-year-old woman with a history of asthma is admitted to the emergency department with an asthma exacerbation secondary to a viral pneumonia. Vital signs and laboratory tests on admission are:
Lung sounds: pronounced wheezing noted in all lung fidds. ABGs on room air were:
She is started on oxygen therapy via a non-rebreather mask at 100% 02
IV fluids, steroids, and albuterol continuous nebulizers are also initiated along with empiric antibiotics. Within 30 minutes, her BP, heart rate, and respiratory rate have decreased to normal values, with improvement in her Pao2 level (81 mm Hg). She is transferred to the critical c:are unit 3 hours later. The patient is stable until approximatdy 6 hours following her admission to the hospital. At that time, she becomes increasingly short of breath, begins wheezing, and has an increased heart rate, BP, and respiratory rate. ABG shows a respiratory acidosis with partial compensation and hypoxemia despite 4 L of 0 2 by nasal cannula:
The patient is intubated with a 7.5-mm oral endotraclieal tube (ET) tube without difficulty and placed on a ventilator (mode, SIMV; rate, 15/min; Vn 600 mL; Fio2, 0.5; positive end-expiratory pressure [PEEP], 5 cm H20). Immediatdy after intubation and initiation of mechanical ventilation, her BP drops to 90/64 mm Hg. Following a 500-mL bolus ofIV fluids, her BP is 118/70. ABG 15 minutes after intubation is as follows:
Why do you think the patient's BP decreased after intubation?
What ventilator changes if any would you anticipate?