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Respiratory Failure & Mechanical Ventilation
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i have completed my course but it shows 97% but all the boxes are marked . & i am unable to download my certificate , what should i do ?
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Good day, everyone!
I would like to discuss a case involving an asthmatic patient who is on continuous bronchodilator therapy due to severe bronchospasm. As you can see in the video, I have provided the settings along with the measurements. What do you think about this situation? I should mention that this patient has only ventilation issues, and the last blood gas result indicated a pH of 7.08 with CO2 125.
Plat: 32
AutoPEEP: 16
What are your thoughts?
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The flow-time scalar indicates as well that the Tinsp is short when the inspiratory flow does not return to baseline. The short Tinsp prevents the set VT from being delivered, which may cause the patient's VT to be significantly lower (143 ml) than the set value (300 ml) and contribute to hypoventilation. This low Vt with high Ppeak can explain the low Cdyn (2.1 ml/cmH2O).
For a patient with increased Raw, I recommend setting the respiratory rate (RR) lower than the current value. The patient has a RR set of 20 bpm, and the increase in Raw may contribute to the level of auto-PEEP mentioned previously. However, I would like to emphasize that the expiratory flow is returning to baseline, which is not consistent with the presence of auto-PEEP in this patient.
I prefer a range of a RR between 8 to 12 bpm and using a Vt of 7 to 8 ml/kg of IBW in ventilated patients with an increase Raw.