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 pa
| 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. What can you do to improve his oxygenation? | |||
| Selected Answer: To improve oxygenation, consider increasing the PEEP pressure to help open the alveoli and prevent the closure of small airways, an intervention that is effective in ARDS, pulmonary edema or alveoli hemorrhage. However, note that high PEEP pressure may distant the capillaries and result in in impaired venous return, which may in turn decrease the cardiac output. Be sure to monitor PaO2 and SaO2 to ensure that the patient if getting enough oxygen to to prevent the mentioned complications. Correct Answer: |
