Where does APRV fit in the grid of Mode vs. Type of ventilation?
With regards to this TRALI patient post tracheostomy and trache-collar trial in progress for > 12hrs,
a) how do you think the patient is doing?
b) what do you think the physician thinks how this patient is faring?
c) how do you think the physician decided to manage this patient?
d) how would you handle this patient in the next 12hrs?
This is the patient who continued on a trache collar trial for approximately 18 hours.
The patient had stable vital signs with a HR=80-84, RRspont=18-22 and SpO2~95%.
The patient was sleeping very comfortablly and without signs of respiratory distress (no costal retractions and no nasal flaring).
The CXR and ABG are shown above.
I have heard a lot of people (if not everyone I have known) tell patients “it is really hard breathing thru that small tube (i.e. ETT) but hang in there and we will have that tube out in a little bit”.
Using the graph of Edi, explain why breathing thru the ETT is actually easier than post extubation.
Hint : compare #3 vs #5 (the assumption is that the higher the microvoltage that the brain sends down to the diaphragm, the more distressed the brain “feels”).
Good luck !
Looking forward to the answers.
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