医学
鼻插管
麻醉
机械通风
呼吸频率
压力支持通气
自主呼吸试验
动脉血
呼吸衰竭
呼吸窘迫
感染性休克
插管
吸入氧分数
通风(建筑)
心率
套管
血压
外科
内科学
败血症
机械工程
工程类
作者
Deepti Kilaru,Nova L. Panebianco,Cameron Baston
出处
期刊:Chest
[Elsevier]
日期:2021-03-01
卷期号:159 (3): 1166-1172
被引量:10
标识
DOI:10.1016/j.chest.2020.12.003
摘要
A 65-year-old man was admitted to the ICU for septic shock due to pneumonia. He remained on mechanical ventilation for 96 hours. His shock resolved, and he no longer required IV vasopressor therapy. His vital signs included a BP of 105/70 mm Hg, heart rate 85 beats/min, respiratory rate 22 breaths/min, and oxygen saturation 95%. His ventilator settings were volume control/assist control with a positive end-expiratory pressure of 5 and an Fio2 set to 40%. On these setting his blood gas showed an Pao2 of 75 mm Hg. He was following simple commands and had minimal tracheobronchial secretions. He was placed on a spontaneous breathing trial with a spontaneous mode of ventilation and pressure support of 7/5. He remained hemodynamically stable and showed no distress through the procedure, so he was extubated to 6 L oxygen by nasal cannula. Eighteen hours later, the patient was found to have increased work of breathing, with use of accessory respiratory muscles. A blood gas showed an elevated level of CO2, so the patient was reintubated. After intubation, the patient again appeared comfortable on minimal ventilator settings. Chest radiography before reintubation showed no new parenchymal process, but an elevated left diaphragm. After a thorough workup, it was determined that diaphragmatic weakness was the most likely reason for respiratory failure. The team questioned whether there was a way to have detected this before extubation.
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