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MaxDoc, Doctor
Category: Medical
Satisfied Customers: 192
Experience:  7 years+ experience in Healthcare Delivery and Life-Sciences Consulting; ECFMG certified
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Patient is on ALS patient on mechanical ventilator settings

Resolved Question:

Patient is on ALS patient on mechanical ventilator settings A/c 10, vt 650, It 1.5, ABG 7.47 pc02 25, po2 89, HCO3 18 (Chronic respiratory Alkolosis) he is in distress. How could the vent settings be adjusted so he can be more comfortable.
Submitted: 7 years ago.
Category: Medical
Expert:  MaxDoc replied 7 years ago.
Is the patient sedated and paralysed? What do you mean by ALS?
Customer: replied 7 years ago.
Amyotrophic Lateral Sclerosis is a progressive terminal disease affecting the central nervous system. I want to know if we should ask the MD to decrease the rate which is now 10 or the tidal volume which is now 650ML for the patient to retain CO2 SINCE IT IS SO LOW AND HE IS NOT COMFORTABLE.
Expert:  MaxDoc replied 7 years ago.

In my opinion -
1. The tidal volume should be decraesed.
2. The rate might even be increased to 12 , 10 might be too low and that is why he might be overworking to wash out CO2 harder than required.
3. the patient could be sedated and if required paralysed for some time till the distress settles down.
4. it would help to get a fresh xray done.

Customer: replied 7 years ago.

The patient is at home, cannot be sedated.

Expert:  MaxDoc replied 7 years ago.

Then it would help to -
1. decrase the tidal volume - 6 - 8 ml / kg body weight is sufficient.
2. increase the length of the ventilator tubing.
3. The patient cannot be paralysed at home, but surely a mild sedative can be given in discussion with his doctor.
4. Correct oxygenation and aim at a PaO2 of more than 90%
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