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A 27-year-old female with Acute Respiratory Distress Syndrome (ARDS) is ventilated on Intensive Care. Her inspired oxygen is 100%, Positive End Expiratory Pressure is 15cmH20 and Peak Airway Pressure is 40cmH2O. Her arterial blood gas shows:
PaO2 6 kPa (11.3-12.6)
PaCO2 6.9 kPa (4.7-6.0)
SpO2 88% (>92%)
Which further ventilatory strategy is appropriate in this case? (September 12)
A. Intravenous Oxgenation (IVOX)
B. Inhaled nitric oxide therapy
C. High Frequency Oscillatory Ventilation (HFOV)
D. Prone position
E. Increasing tidal volume and respiratory rate on the ventilator
Explanantion/Rationale :
This lady is on maximal ventilator therapy, but is still hypoxic. Her high CO2 is a reflection of permissive hypercapnia to prevent overdistension of the lungs with high tidal volumes.
None of the therapies above are proven to improve mortality. However proning a patient in this situation will improve ventilation/perfusion mismatch and temporarily improve oxygenation. Some clinicians would move immediately to HFOV without proning as placing a patient face down is obviously fraught with difficulty. IVOX is complicated and require specialist equipment and is not proven. Nitric oxide therapy to improve hypoxic pulmonary vasoconstriction is used infrequently.
PaO2 6 kPa (11.3-12.6)
PaCO2 6.9 kPa (4.7-6.0)
SpO2 88% (>92%)
Which further ventilatory strategy is appropriate in this case? (September 12)
A. Intravenous Oxgenation (IVOX)
B. Inhaled nitric oxide therapy
C. High Frequency Oscillatory Ventilation (HFOV)
D. Prone position
E. Increasing tidal volume and respiratory rate on the ventilator
Explanantion/Rationale :
This lady is on maximal ventilator therapy, but is still hypoxic. Her high CO2 is a reflection of permissive hypercapnia to prevent overdistension of the lungs with high tidal volumes.
None of the therapies above are proven to improve mortality. However proning a patient in this situation will improve ventilation/perfusion mismatch and temporarily improve oxygenation. Some clinicians would move immediately to HFOV without proning as placing a patient face down is obviously fraught with difficulty. IVOX is complicated and require specialist equipment and is not proven. Nitric oxide therapy to improve hypoxic pulmonary vasoconstriction is used infrequently.
