10-07-2006, 07:46 AM
A 72-year-old man with a 25-year history of emphysema comes to his physician after he
develops the acute onset of fevers, rigors, and a cough productive of green sputum. The
symptoms gradually worsen over 36 hours and he comes to the emergency department. He
has been taking a beclomethasone inhaler twice daily, an albuterol nebulizer treatment at
home four times daily, and has been taking erythromycin for a recent bronchitis. On physical
examination he is 183 cm (6 feet) tall and weighs 85 kg. His temperature is 38.3 C (100.9 F),
blood pressure is 162/92 mm Hg, pulse is 94/min, and respirations are 32/min. His lung
examination reveals diffuse bilateral coarse rhonchi. He uses his sternocleidomastoid muscles
with each inspiration. An arterial blood gas reveals a pH of 7.20, a pCO2 of 60 mm Hg, and a
pO2 of 52 mm Hg. Over the next 2 hours, he becomes increasingly tachypneic, and his pCO2
rises to 74 mm Hg. The decision is made to intubate him at that point. Which of the following
settings would be most appropriate for his tidal volume on the respirator?
A. 500 mL/breath
B. 600 mL/breath
C. 700 mL/breath
D. 850 mL/breath
E. 1000 mL/breath
develops the acute onset of fevers, rigors, and a cough productive of green sputum. The
symptoms gradually worsen over 36 hours and he comes to the emergency department. He
has been taking a beclomethasone inhaler twice daily, an albuterol nebulizer treatment at
home four times daily, and has been taking erythromycin for a recent bronchitis. On physical
examination he is 183 cm (6 feet) tall and weighs 85 kg. His temperature is 38.3 C (100.9 F),
blood pressure is 162/92 mm Hg, pulse is 94/min, and respirations are 32/min. His lung
examination reveals diffuse bilateral coarse rhonchi. He uses his sternocleidomastoid muscles
with each inspiration. An arterial blood gas reveals a pH of 7.20, a pCO2 of 60 mm Hg, and a
pO2 of 52 mm Hg. Over the next 2 hours, he becomes increasingly tachypneic, and his pCO2
rises to 74 mm Hg. The decision is made to intubate him at that point. Which of the following
settings would be most appropriate for his tidal volume on the respirator?
A. 500 mL/breath
B. 600 mL/breath
C. 700 mL/breath
D. 850 mL/breath
E. 1000 mL/breath