Gaurav Jain1, Pranav Bansal2
1Assistant Professor, Department of Anaesthesiology, Institute of medical sciences, Banaras Hindu University, Varanasi
2Professor, Department of Clinical Skills, Medical University of the Americas, St. Kitts and Nevis, West Indies
A 40-year old male patient is admitted to ICU with complains of purulent cough, fever, restlessness and difficulty in breathing. He has past history of asthma for 10 years, managed on inhaled bronchodilators. Since past one month he was started with oral prednisolone 10 mg OD due to exacerbation of symptoms. On physical examination his respiratory rate is 36 breaths/ min, O2 saturation 71 %, HR 130/min and BP 140/86 mmHg. He is initially provided BIPAP support with high flow O2 but deteriorates and becomes unconscious. Patient is intubated and kept on ventilator support in CMV mode with infusion of vecuronium and midazolam. On 2nd day of admission his SpO2 and PaO2 readings show declining trends and the attending anesthesiologist changes the ventilator mode to airway pressure release ventilation (APRV) with increase in FiO2 to 90%. The patient shows improvement by next day and is weaned off from ventilator over next 2 days.
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REFERENCES
- Tobin MJ. Principles and Practice of Mechanical Ventilation. 3rd edition, 2013. Mc Graw Hill Publishers, New york, US.
- Chang DW. Clinical application of Mechanical Ventilation. 4th edition, 2014. Delmer Publishers, New York, US.
