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What’s the next step in ventilating this patient with ARDS?




Last update: Saturday, 22 Feb 2020 at 13:09

A 50-year-old man was admitted to the ICU with dyspnea, runny nose, sore throat and fever for 3 days. On physical examination, he presented tachypnea (RR: 26bpm), HR: 110bpm, PA: bronchial sound in lung basis, pH: 7.48, PaO2: 75mmHg, PaCO2: 31mmHg, SaO2 : 95% with O2 by 50% Venturi mask. He underwent a chest CT scan, whose scan and representative sections are shown below:

Captura De Tela 2014 06 26 às 01.54.40 Pm

The echocardiogram showed mild pulmonary hypertension.

The patient was intubated. with the Patient was kept under profound sedation (RASS: -5) and neuromuscular blockade (cisatracurium), in the volume controlled (VCV) mode, with VT: 420ml (6ml/kg, ideal body weight), RR: 26bpm, PEEP titrated to the lowest driving pressure: 14cmH2O, FIO2: 60% and plateau pressure: 28cmH2O, driving pressure: 14cmH2O . Arterial blood gases showed: pH: 7.34, PaO2: 70mmHg, PaCO2: 54mmHg, HCO3: 24 mEq/l and SaO2: 97%.

What is the recommended next step for this patient's ventilatory support?

a) Prone position.
b) Use of nitric oxide by inhalation.
c) Maximum alveolar recruitment maneuvers.
d) Institution of ECMO (extracorporeal membrane oxygenation).

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