Question

A post-operative patient is receiving mechanical ventilation in the ICU at the following settings: VC, A/C; VT 550 mL, respiratory rate 14/min, FIO₂ 0.50 and 10 cm H₂O PEEP. Bedside monitoring results demonstrate that the PvO2 is 35 mm Hg and the SpO₂ is 90. What should be the next step in the management of this patient?

1) Decrease the PEEP.
2) Increase the FIO₂.
3) Initiate diuretic therapy.
4) Continue to monitor closely.

Answer 1

The next step in the management of this patient should be to increase the FIO₂. By increasing the FIO₂, the patient will receive a higher concentration of oxygen, improving oxygenation.

Step-by-step explanation:

The next step in the management of this patient should be to increase the FIO₂. The PvO₂ value of 35 mm Hg suggests inadequate oxygenation in the blood, as a normal value ranges between 35-45 mm Hg. The SpO₂ value of 90 also indicates lower than normal oxygen saturation. By increasing the FIO₂, the patient will receive a higher concentration of oxygen, improving oxygenation.

Decreasing the PEEP would not be the appropriate next step, as PEEP helps to keep the alveoli open and prevent them from collapsing. Initiation of diuretic therapy is not indicated based on the information provided. Continuing to monitor closely is always important, but the next step in management should focus on improving oxygenation.