4. A 5 ft 2 in., 115-lb, 67-year-old woman
with a history of myasthenia gravis was
brought to her physician’s office by her
daughter. She complained of
progressive muscle weakness.
Physical examination revealed that she
demonstrated drooping eyelids and
difficulty talking and swallowing. She
was unable to walk more than a step or
two.
5. What is the
relationship between
height and
mechanical
ventilation?
6. She was transferred to the hospital,
where she was given edrophonium
(Tensilon), which improved her muscle
function for 10 to 15 minutes.
On admission, her vital signs were
unremarkable. Her maximum
inspiratory pressure (MIP) was -60 cm
H2O, and her vital capacity (VC) was 1.8
L (predicted was 3.3 L). Her SpO2 on
room air was 96%.
7. Why is vital capacity
so important in
neuromuscular
disorders?
11. How much pressure ? IPAP ?? EPAP???
TO BEGIN WITH LOW PRESSURES SUCH AS
IPAP=10,EPAP=5 CM OF H20, AND THEN
READJUST.
FIO2?
USUALLY LOW AS LUNGS ARE MORE OR LESS
NORMAL
DO THEY NEED BACKUP RATE?
Yes , back up rate of 10-12/mt
12. Spontaneous tidal volume and
respiratory rate
Vital capacity and maximal inspiratory
pressure
Periodic arterial blood gases
13. Anticholinesterase therapy was administered, and
MIP and VC were monitored every 8 hours.
The nursing staff reported that the patient was having
trouble swallowing when she ate and they feared
that she would aspirate. MIP and VC values
progressively declined. After being hospitalized for
24 hours, her MIP was −25 cm H2O and VC was 1.0
L.
ABGs on room air were as follows: pH = 7.36; PaCO2
= 48 mm Hg; PaO2 = 62 mm Hg; HCO3 −= 27 mEq/L.
Could noninvasive positive pressure ventilation (NIV)
be used in this situation?
14. Will you intubate or not?
The patient should be intubated and
ventilated.
15. What would be the mode,rate,tidal volume,
inspiratory time,PEEP,FiO2,Flow waveform?
ANSWER IS ----------------------------------------
18. The patient is intubated and put on A/C
CMV(VC),TV=8ml /IBW,RR=12/mt,PEEP=5 cm of
H2O,FIO2=.5
ABG done after 30 minutes which shows
PH=7.47,PACO2=27,PAO2=102, HCO3=22
19. After 2 days of ventilation , and
anticholinesterase therapy, patients VC improves
to 2lit/mt Which was more than 50% of the
predicted, MIP = -70 cm H2O.
20. CAN WE THINK OF EXTUBATING HIM
NOW?
Yes ,Now The Patient Is Successfully
Extubated
21. It is a cough assist device ,which stimulates
cough by inflating the lungs with pressure
,followed by a negative airway pressure to
produce a high expiratory flow.
