A 21-year-old man got into traffic accident and fell from height. He was diagnosed as severe diffuse axonal injury and refractory intracranial hypertension.

• Monitoring was placed and brain metabolic suppression was done by thiopental infusion.
• His condition was complicated by VAP and severe ARDS after 3 days on MV.
• His CXR, ABG results and ventilator waveform were shown above.

Questions:

1.What is the physiologic explanation for non-improving PaCO2 after increase respiratory rate?

2.What should be done to improve PCO2 by ventilator adjustment?

โดย น.ท.จรัส ปิตวิวัฒนานนท์ อาจารย์หน่วยโรคระบบการหายใจและเวชบำบัดวิกฤต กองอายุรกรรม รพ.ภูมิพลอดุลยเดช พอ.

ANSWERs