Question

A patient receiving volume-controlled ventilation has the following data on the ventilator flow sheet. 10 pm: Plateau pressure (Pplat) 20 cm H₂O, Peak pressure (Ppeak) 28 cm H₂O, PEEP 5 cm H₂O, Set VT 600 mL, Return VT 596 mL. 11 pm: Plateau pressure (Pplat) 30 cm H₂O, Peak pressure (Ppeak) 38 cm H₂O, PEEP 5 cm H₂O, Set VT 600 mL, Return VT 599 mL.

Which of the following can best explain these data?
1) secretions in the airways
2) pulmonary edema
3) kinked patient circuit (tubing)
4) wheezing

Answer 1

The increase in both peak pressure and plateau pressure over time on the ventilator flow sheet suggests increased airway resistance, which could be caused by secretions in the airways or a kinked patient circuit.

Pulmonary edema and wheezing are unlikely causes.

Step-by-step explanation:

The data on the ventilator flow sheet suggests that there has been an increase in both peak pressure (Ppeak) and plateau pressure (Pplat) over time, while the set tidal volume remains constant.

This increase in both pressures could indicate increased resistance in the airways, which can be caused by factors such as secretions in the airways or a kinked patient circuit.

Secretions in the airways can obstruct the flow of air, leading to an increase in airway resistance and an increase in both Ppeak and Pplat.

Similarly, a kinked patient circuit can also restrict the flow of air, resulting in higher pressures. Pulmonary edema and wheezing are unlikely to be the main causes of the observed pressure differences.