โโAge/gender : 54y/o male
โ
๐ โโ Diagnosed as ARDS, H1N1 positive, later found to have ICH
โโ ๐๏ธ Medical history : Nil
๐๐ปโโ๏ธ โโAdm wt.60kg, ht.168cm.
โโ Current wt: 54.0
โโ๐Infusions:
โโ๐นFentanyl 100 mcg/hr
๐นMedazolam 5 mg/h
๐น Rocuronium 10 mcg/kg/min (held off)
โโ๐นD5N@50ml/hr
โโ๐ฉธ RBS: 198mg/dl (RI- LDSS)
โโ
โโ๐๏ธECMO V-V : ( Day 4)
โโ*FLOW - 4.0
*FIO2 - 50%
*SWEEP - 4
โโ*โp 60
โโ
โ
๐นPatient tachycardia 125-130
๐น Tachypneic in ventilator
Screenshot of the ventilator today is showing the following:
What would you do next:
What changes would you make?
0%Decrease inspiratory time
0%Increase inspiratory time
0%Resume paralytic agent
0%Increase PC level
Thank you Dr. @Ibrahim Ameen for a nice case.
Interesting answers, it looks like this is a case of delayed cycling indicated by increase inspiratory flow at end of inspiration in every single breath. Notice the increase in volume at the same time. This may lead to double triggering if the inspiratory negative pressure continued and was at the level to trigger another breath. However, we need to rule out reverse triggering by applying expiratory hold and notice if these efforts disappear. If they disappear then the answer to the question would be resuming paralysis, if they did not then we need to shorten inspiratory time on the ventilator first and re-evaluate.