Ventilatory management in a patient with chronic obstructive pulmonary disease: a need for caution
AbstractA 67 year old obese male patient, chronic smoker, is admittedto the Intensive Care Unit (ICU) with complaints of acuteshortness of breath which has progressively increased overthe past 10 days. He is a known case of paroxysmalbreathlessness for the past 17 years and has been ontreatment from his family physician with oral and inhaledbronchodilators. Since the patient’s condition progressivelyworsened in spite of home treatment, his family physicianreferred him to the hospital. On examination, the patient isdrowsy and cyanosed with a very poor respiratory drive. Hispulse rate is 86/min, regular and bounding. His BP is 156/92 mmHg. His chest examination reveals diminished air entrybilaterally over the chest, with prolonged expiration andscattered rhonchi. He is immediately transferred to the ICUand put on a volume-cycled ventilator (respirator) with assistcontrol (AC) mode, a high respiratory rate and FiO2 of 80%.Four hours later, the patient is found to have developed cardiacarrhythmias. His ECG shows ventricular prematurecontractions (VPC’s) with occasional supraventricularpremature beats. The arterial blood gases (ABG) done onadmission and 4 hours after ventilatory management. (copied from article)
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