Question

After starting volume-cycled mechanical ventilation on a patient in respiratory failure with a VT of 10 ml/kg, you measure and obtain a plateau pressure of 45 cm H2O. Which of the following actions would you recommend to the patient's physician?

A) Decrease the inspiratory flow.

B) Lower the delivered VT.

C) Administer a bronchodilator.

D) Add PEEP.

Answer 1

In response to a plateau pressure of 45 cm H2O in a patient on volume-cycled mechanical ventilation, the recommended action would be to lower the delivered tidal volume to decrease the risk of lung injury.

Step-by-step explanation:

After starting volume-cycled mechanical ventilation on a patient in respiratory failure with a VT of 10 ml/kg, and obtaining a plateau pressure of 45 cm H2O, it's a concern since the pressure is higher than the recommended upper limit of 30 cm H2O, reflecting a risk for barotrauma or volutrauma. The most appropriate action to suggest to the physician would be to lower the delivered VT (Tidal Volume). Tidal volume is an adjustable setting on mechanical ventilators, and reducing it can help lessen the pressure in the airways and alveoli, potentially reducing the risk of lung injury. Alveolar overdistention can be minimized by reducing tidal volume, which is consistent with lung protective ventilation strategies employed in patients with acute respiratory distress syndrome (ARDS) or other forms of respiratory failure. None of the other provided options directly address the high plateau pressure problem as effectively as reducing the tidal volume.