A 65-year-old man with a BMI of 42 is admitted to ICU following emergency laparotomy for bowel perforation. He is intubated. Ventilator settings: VCV,...

Question

A 65-year-old man with a BMI of 42 is admitted to ICU following emergency laparotomy for bowel perforation. He is intubated. Ventilator settings: VCV, TV 480 mL (IBW 80 kg), PEEP 8 cmH2O, FiO2 0.5, RR 18/min. ABG: pH 7.34, PaO2 8.2 kPa, PaCO2 6.2 kPa, HCO3 24 mmol/L. SpO2 91%. Plateau pressure is 30 cmH2O. What is the most likely explanation for the poor oxygenation and elevated plateau pressure?

Accepted Answer

Inadequate PEEP leading to atelectasis from raised intra-abdominal pressure and obesity

Answer

Excessive tidal volume causing overdistension

Answer

Developing ARDS secondary to bowel perforation

Answer

Right main bronchus intubation

Answer

Pneumothorax on the left side

uk-fficm MCQ (SBA): Obesity and Atelectasis