Critical Care Question

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You are rounding on a ICU patient who has been on the ventilator for the past 4 days due to respiratory failure from community acquired pneumonia.  She has been gradually weaned down to the following settings:

 

Pressure Support Mode

PEEP – 6 cmH2O

Pressure Support – 8 cmH2O

Oxygen – 0.40

 

She is A&Ox3 and follows commands. Vital signs show BP – 122/72 mmHg, HR – 78, RR – 15, O2 – 100%, Temp – 99.8.

 

  1. What is your next step?
  2. What bedside measurements or tests can you do to help with your decision?

 

 

One thought on “Critical Care Question”

  1. You could do a few things to “seal the deal” on your decision to extubate, you could place her on zero pressure support and zero PEEP for ~ 15-30 min., and if she tolerates well, you could say confidently that she would fly on her own. You could also check a NIF to make sure it’s > – 20cmH2O and a vital capacity to make sure it’s > 1L. If all checks out, extubate to oxygen device of your choice.

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