How to Adjust the Minute Ventilation on a Ventilator (TMC Practice Question)

This video breaks down a TMC Practice Question about making the proper adjustments to a patient's Ventilator Settings. ✅

➡️ Question
A 52 kg female patient is receiving volume control A/C mechanical ventilation with a tidal volume of 400 mL, a set rate of 10/min, and an FiO2 of 35%. Her blood gas results are as follows:
pH 7.31
PaCO2 49 torr
HCO3 24 mEq/L
BE -2 mEq/L
PaO2 84 torr
SpO2 95%

Based on the given information, which of the following changes is appropriate at this time?
A. Increase the FiO2
B. Increase the tidal volume
C. Increase the set rate
D. Maintain the current settings

Let break it down. The first thing we need to do is interpret the ABG results. A decreased pH with an increased PaCO2 and a normal bicarb indicates:

➡️ Acute Respiratory Acidosis

And by looking at the PaO2 and SpO2, we can see that the patient's oxygenation status is satisfactory. So now we need to figure out what can we do to correct the respiratory acidosis to get the pH back into the normal range?

The elevated PaCO2 level is what's causing the pH to be acidotic. This means that we need to blow off some of that excess CO2 and we can do so by increasing the minute ventilation.

➡️ There are 2 ways to increase minute ventilation:
-- Increase the rate
-- Increase the tidal volume

The question provides us with the patient's weight of 52 kg and the set tidal volume is 400 mL. We can use this data to calculate whether or not the tidal volume is set appropriately: 400/52 = 8 mL/kg

8 mL/kg falls perfectly within the appropriate tidal volume range of 5-10 mL/kg which tells us that the tidal volume is set correctly. Now we can be certain that, in order to lower the PaCO2, we need to increase the rate.

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🚑MEDICAL DISCLAIMER
Medicine and Respiratory Therapy are continuously changing practices. The information in this video is for educational and entertainment purposes only. For medical advice, please consult with a physician or qualified medical professional.

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⏰TIMESTAMPS
0:00 - Intro
0:26 - Practice Question
1:25 - Explanation
3:25 - Correct Answer

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#MechanicalVentilation #RespiratoryTherapy #RespiratoryTherapist #RespiratoryTherapySchool

[RespiratoryTherapyZone]

This video breaks down a TMC Practice Question about making the proper adjustments to a patient's Ventilator Settings. ✅

[ClassieLadie]

Yes! Knew the answer! 😄 might be something small but gives me a boost of confidence! Something is sticking to my head to say the least! Thank you for the practice!! 😊

[Jason-bntn]

I see what the right answer is. Initially I thought the answer would be to increase the FIO2 since the PaO2 was in the 80s