A Case Study on Positive Pressure Ventilation in a Patient with Neurologically Induced Respiratory Failure

Conduct research relevant to your case study using the Internet, Concorde Library, clinical site library, and any other appropriate sources. Review a variety of sources including professional journals, reputable websites, research papers, and books. Write a 6-page APA formatted paper in which you address the following: Cover the entire medical case of a patient from their entrance to the hospital to the present time. Include the assessments, treatment decisions, and outcomes of those treatments. Include the explanation, rationale and outcomes of patient assessment, disease/trauma pathology, ventilator strategy and management, respiratory therapeutics, patient education, pulmonary rehabilitation and experimental therapies. Include the long-term prognosis of the patient. NOTE: These are not copies of the patient’s chart. This should be written in an explanatory essay style. Support your paper with a minimum of 7 peer-reviewed and/or scholarly resources, excluding the course textbooks. here’s the information I gathered about my patient Patient Ventilator Case Study Initials: J.T. Age/Sex: 67-year-old male Height: 5’10” Weight: 85 kg Admitting Diagnosis: Acute-on-chronic hypercapnic respiratory failure secondary to COPD exacerbation Medical History: • Chronic Obstructive Pulmonary Disease (COPD) – chronic bronchitis type • Hypertension • Former smoker (40 pack-years) • Home use of CPAP at night Chief Complaint: Increased dyspnea, productive cough, fatigue, and confusion. Family reports increased oxygen demand and lethargy for two days prior to admission. ⸻ Clinical Presentation Upon Admission • Respiratory Rate: 32 bpm (labored, using accessory muscles) • Heart Rate: 110 bpm • Blood Pressure: 154/91 mmHg • SpO2 on 6 L/min nasal cannula: 85% • Auscultation: Bilateral wheezing and diminished breath sounds • Mental Status: Lethargic, confused • Chest X-ray: Hyperinflation, flattened diaphragms, no acute infiltrates • ABG on 6 L/min O2: • pH: 7.24 • PaCO2: 78 mmHg • PaO2: 54 mmHg • HCO3−: 34 mEq/L ⸻ Initial Ventilator Settings (VCV): • Mode: Volume-Controlled Ventilation • Rate: 16 bpm • Tidal Volume (VT): 500 mL (~6 mL/kg IBW) • FiO2: 40% • PEEP: 5 cm H2O • I:E Ratio: 1:3 • Flow Rate: 60 L/min (square waveform) • Sensitivity: -1.5 cm H2O Sedation Ordered: Propofol IV titration (goal RASS -2 to -3) ⸻ Ventilator Monitoring and Assessment (24–48 hours): • Improved synchrony after bronchodilator therapy (Albuterol/Ipratropium) • Peak Pressure: 24 cm H2O • Plateau Pressure: 18 cm H2O • AutoPEEP: Not detected • Ventilator Graphics: No evidence of significant air trapping, normal flow-time return to baseline • ABG after 24 hrs on vent (FiO2 40%): • pH: 7.35 • PaCO2: 59 mmHg • PaO2: 75 mmHg • HCO3−: 31 mEq/L • Mental Status: More alert, following commands ⸻ Respiratory Therapy Plan of Care Short-Term Goals: 1. Improve ventilation and oxygenation within 48 hours 2. Achieve ABG with pH > 7.35 and PaCO2 < 60 mmHg 3. Decrease work of breathing and respiratory rate 4. Prevent ventilator-associated complications (VAP, barotrauma) Interventions: • Maintain current ventilator settings and monitor ABGs every 8–12 hours • Administer bronchodilators via in-line MDI or SVN every 4 hours and PRN • Perform ventilator checks and suctioning every 2–4 hours • Monitor ventilator graphics for signs of autoPEEP or patient-ventilator asynchrony • Elevate HOB to ≥ 30° to prevent aspiration • Daily sedation vacation and spontaneous breathing trial (SBT) when clinically appropriate • Oral care protocol every 4 hours with chlorhexidine • Chest physiotherapy and flutter valve therapy as tolerated • Encourage early mobilization once stable Long-Term Goals: 1. Wean from ventilator within 5–7 days 2. Return to baseline oxygen needs (home CPAP or nasal cannula) 3. Educate patient on COPD management, inhaler use, and smoking cessation (if applicable) ⸻ Weaning Criteria (once stable): • Respiratory rate < 30 bpm • Spontaneous tidal volume > 5 mL/kg • Rapid Shallow Breathing Index (RSBI) < 105 • FiO2 ≤ 40% and PEEP ≤ 5 cm H2O • Mental status: awake and alert • Stable ABG (pH > 7.35, PaCO2 trending down, PaO2 > 60) ⸻ Outcome (Projected): With continued therapy, bronchodilation, and pulmonary hygiene, the patient is expected to be weaned to CPAP or nasal cannula within 5–7 days and discharged home or to pulmonary rehab