A 3-day-old premature neonate was born at 24-weeks estimated gestational age. The patient is mechanically ventilated with a fraction of inspired oxygen (FiO2) of 30%, rate of 40 breaths per minute, positive end expiratory pressure of 5, and peak inspiratory pressure of 20. The arterial blood gas results are as follows: pH = 7.34, PaCO2 = 48 mmHg, PaO2 = 70 mmHg, and HCO3 = 25 mEq/L. The nurse anticipates which changes will be made to the patient’s ventilator settings?

Question

A 3-day-old premature neonate was born at 24-weeks estimated gestational age. The patient is mechanically ventilated with a fraction of inspired oxygen (FiO2) of 30%, rate of 40 breaths per minute, positive end expiratory pressure of 5, and peak inspiratory pressure of 20. The arterial blood gas results are as follows: pH = 7.34, PaCO2 = 48 mmHg, PaO2 = 70 mmHg, and HCO3 = 25 mEq/L. The nurse anticipates which changes will be made to the patient&rsquo;s ventilator settings?

Accepted Answer

No changes will be made. Extremely premature infants are at risk for barotrauma to the lungs due to mechanical ventilation. Therefore, a mainstay of therapy for these patients is permissive hypercapnia, which consists of using the minimum necessary ventilator settings and allowing the patient to have a slightly acidotic pH with a higher CO2. Additionally, extremely premature infants are at risk for damage to their lungs and eyes due to high oxygen levels, which means a lower PaO2 is acceptable for these patients. Therefore, the patient&rsquo;s ABG results are appropriate and do not require changes at this time. Increasing the respiratory rate, PEEP, and FiO2 are unnecessary changes that may cause damage to the patient. However, the patient is not over-oxygenated or over-ventilated, so decreasing the peak inspiratory pressure is not appropriate.

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