Case Based Pediatrics Chapter | 合法醫療器材資訊網

SIMV(synchronizedintermittentmandatoryventilation)pressuresupport:Thismethodsynchronizestheventilatorbreathswiththepatient'sinspiratoryefforts, ...

A 4 month old, 6 kg girl is admitted to the PICU for respiratory failure. She is cyanotic and retracting. She is intubated due to worsening tachypnea, increasing work of breathing, and fatigue. Her oxygen saturations have been falling and her pCO2 is 75 on an arterial blood gas. With intubation, her oxygen saturations briefly improve as she is hand ventilated, but her oxygen saturation falls into the high 80s when placed on mechanical ventilation, SIMV (synchronized intermittent mandatory ventilation) mode with a tidal volume of 80, IT=0.7 seconds, FiO2=100%, PEEP=5, and rate of 25. Her saturations again rise to 98-100% with hand bagging. After numerous attempts to ventilate her with volume ventilation she is changed to SIMV pressure control/pressure support mode, PIP=30, PEEP=6, FiO2=60%, RR=25, IT=0.7 and her saturations remain 98-100% on mechanical ventilation. CXR shows her ET tube to be in good position, but there are bilateral, patchy infiltrates and right lower ...