A patient is admitted to the ICU with severe necrotizing pancreatitis. Three hours after admission his oxygen saturations decreased and he was intubated for hypoxia. Initially his oxygen saturation improved to 94% on FiO2 of 50% but over the past two hours his FiO2 has been increased to 70% and his saturation is 89%. The patient is on 5 cm H2O of PEEP.  His current ABG shows pH 7.34, pCO2 36, PO2 61, HCO

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NRNP 6566 WEEK 7 KNOWLEDGE CHECK

  • Question 1

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Ungraded A patient is admitted to the ICU with severe necrotizing pancreatitis. Three hours after admission his oxygen saturations decreased and he was intubated for hypoxia. Initially his oxygen saturation improved to 94% on FiO2 of 50% but over the past two hours his FiO2 has been increased to 70% and his saturation is 89%. The patient is on 5 cm H2O of PEEP.  His current ABG shows pH 7.34, pCO2 36, PO2 61, HCO3 21 on an FIO2 of 80%. The patient’s repeat chest x-ray shows diffuse bilateral opacities in a pattern consistent with pulmonary edema. An echo earlier today was read as normal. How would you explain his worsening oxygen status?
Selected Answer: Based on the presentation, the patient may be experiencing an acute respiratory distress syndrome (ARDS) given that he had a normal echo result in the morning. Further, pulmonary edema revealed in his recent repeat xray alongside the pO2 and FiO2 rations further indicate a possible ARDS. To improve the patient’s oxygenation, the initial response should be to increase FiO2 and PEEP. The PEEP will help keep alveoli open and prevent closure of small airways. However, should the intervention fail to improve pO2 levels, consider lowering the PEEP value as higher PEEP may hinder venous return, which may affect the patient’s cardiac output and blood pressure.
Correct Answer: Correct  The patient’s ratio of the PaO2 to FIO2, referred to as the P/F ratio, is 75. He also has an echocardiogram showing evidence of normal left ventricular function. Based on the combination of the x-ray findings, the low P/F ratio and the evidence of normal left ventricular function, this patient should be classified as having developed the Acute Respiratory Distress Syndrome (ARDS). Pancreatitis is one of several known disease states that can predicate this syndrome. Other known precipitants include pneumonia or other forms of severe infection, trauma, severe burns, aspiration of gastric contents, drug overdose and a variety of other processes. Response Feedback: [None Given]

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