Volume Support and Pressure-Regulated Volume Control
A 50-ycar-old man was admitted to the surgical intensive care unit (SICU) following repairs of multiple injuries resulting from a motor vehicle accident. His injuries included multiple leg fractures as well as blunt abdominal trauma. His legs were casted following repair and he was admitted for stabilization and to monitor his abdominal status. He was placed on PRVC (SIMV option) at a rate of 20 with a volume of 500 mL, PEEP of 5, and an Fio2 of 60%. Within 3 hours of his admission to the SICU, his respiratory status deteriorated and his chest x-ray demonstrated pulmonary edema. His abdominal status was stable. ABGs were:
The patient was given 20 mg of furosemide, his PEEP was increased to 10 cm H20 and his control rate was increased to 25. His fentanyl infusion was maintained at 50 mcg/h and he was also given an additional bolus of 50 mcg.
The patient quickly recovered following the above interventions; oxygenation and ventilation improved and he slept well without further incidents. The next morning he was stable, alert, and anxious to get the "tube out." He was placed on VS with a selected tidal volume of 350 mL and an Fio2 of 35%. Following this change, his Sao2 was 98% and spontaneous RR was 20 and nonlabored. The team decided to extubate the patient. He did well and later that day was transferred to an acute care unit.
In this example, the patient was set on PRVC (SIMV option). Instead ofinaea11ingthe controlnte to 25, what other option is available that may assure desired tidal volume in the PRVC mode?
Why did the team select a tidal volume of 350 mL vcnus a higher tidal volume?