{"id":907,"date":"2016-03-21T13:40:56","date_gmt":"2016-03-21T13:40:56","guid":{"rendered":"http:\/\/hfhpulm.com\/info\/?p=907"},"modified":"2016-03-21T13:40:56","modified_gmt":"2016-03-21T13:40:56","slug":"icu-post","status":"publish","type":"post","link":"https:\/\/hfhpulm.com\/info\/?p=907","title":{"rendered":"ICU Post"},"content":{"rendered":"

You have a 70 yo woman with COPD and HTN that was admitted to your ICU service 5 days ago in acute respiratory failure with sepsis due to CAP.\u00a0 She remains intubated and mechanically ventilated.\u00a0 She received early goal directed therapy and needed vasopressor support for the first 3 days of her ICU stay, but has now been weaned off vasopressors.\u00a0 She is on the PAD protocol and is awake, alert, not agitated, and following commands.<\/p>\n

She remains hemodynamically stable and afebrile.\u00a0 She is on Volume assist-control with TV 6mL\/kg IBW, RR 12, FiO2 40% and PEEP 5 cmH2O.\u00a0 O2 saturation is 92% and her pCO2 is normal (42mmHg). Ppk is 25 cmH2O Ppl 20 cmH2O. Her flow and volume tracing is below.<\/p>\n

\"Slide2\"<\/a><\/p>\n

She undergoes weaning parameters which are acceptable, and starts a spontaneous breathing trial with PSV 7.\u00a0 After 10 minutes, she becomes agitated, hypertensive, tachycardic, and tachypneic with a respiratory rate of 32\/min and O2 sat 85%.\u00a0 You place her back on full support with previous ventilator settings and see a Ppk 35 cmH2O and Ppl 30 cmH2O.<\/p>\n

 <\/p>\n

What does the rise in her airway pressures imply?<\/p>\n

Which of the following would confirm the likely reason for her failure on the spontaneous breathing trial?<\/p>\n

A) NIF (negative inspiratory force)<\/p>\n

B) Troponin<\/p>\n

C) Cuff leak test<\/p>\n

D) Serum BNP level<\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

You have a 70 yo woman with COPD and HTN that was admitted to your ICU service 5 days ago in acute respiratory failure with sepsis due to CAP.  She remains intubated and mechanically ventilated.  She received early goal directed therapy and needed vasopressor support for the first 3 days of her ICU stay, but […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"categories":[14],"tags":[],"class_list":["post-907","post","type-post","status-publish","format-standard","hentry","category-fellowship"],"modified_by":"Geneva Tatem","_links":{"self":[{"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=\/wp\/v2\/posts\/907","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=907"}],"version-history":[{"count":5,"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=\/wp\/v2\/posts\/907\/revisions"}],"predecessor-version":[{"id":922,"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=\/wp\/v2\/posts\/907\/revisions\/922"}],"wp:attachment":[{"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=907"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=907"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/hfhpulm.com\/info\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=907"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}