Skip to content

Assembly

Lung Protective Ventilation: More Than Simply Setting the Tidal Volume

Author
Souvik Chatterjee, MD
Department of Critical Care Medicine, Department of Pulmonary Medicine.
Medstar Washington Hospital Center.


Case

A 65-year-old female with a history of peripheral arterial disease (PAD), coronary artery disease (CAD), and s/p CABG 5 years ago presented with acute right sided weakness and was found to have an ischemic stroke in the MCA distribution. She was intubated for mechanical thrombectomy after tPA administration and persistent symptoms. Post-procedure, she was profoundly hypoxic with 02 saturation of 88% on FiO2 1.0 and PEEP 14 cm H20. A lung protective ventilation strategy was initiated using Volume Assist Control ventilation with TV of 6 cc/kg of IBW, PEEP was up-titrated and inhaled epoprostenol was initiated. The patient was sedated with dexmedatomidine and PRN fentanyl. Representative ventilator waveforms are shown below.

Representative ventilator waveforms

Question

The waveforms reveal what potential ventilator associated lung injury risk?

A. Delayed Cycling
B. Atelectrauma
C. Auto-triggering
D. Barotrauma

Answer