Patient intubated due to status asthmaticus

SIMV mode, 70kg, Vt 620 ml,IT 1.7sec, RR 18, Fio2 40%

O2 Sat 98%, pH 7.4, pCO2 30

Expiratory flow is limited with decrease peak expiratory flow

flow does not return to baseline (0)

next BREATH starts before emptying the lung COMPLETELY = AIR TRAPPING

allow more time of expiration

1.Vt was decreased to 7 ml/kg = 480ml previously its 620ml (pCO2 = 30).

See that dynamic hyperinflation has improve lightly

2.RR is slightly elevated, decrease RR to 14 from 18. observe the I:E ratio.

Gaining more time in expiration..DH is improving.

3.Decreasing ITime of 1.7 can help...in which Plateau is eliminated with more prolonged ETime.

expiratory flow is improved,

4.to prolong more expiratory time, increase the flow to 60.

Increasing flow to 60 will deliver the tidal volume more faster, PIP increases but not the plateau pressure.Notice that the AUTO PEEP HAVE BEEN ELIMATED.