A 55-year-old man on ICU with severe ARDS has a respiratory system compliance of 12 mL/cmH2O. He is on TV 300 mL (6 mL/kg IBW), PEEP 16, FiO2 1.0, RR ...

Question

A 55-year-old man on ICU with severe ARDS has a respiratory system compliance of 12 mL/cmH2O. He is on TV 300 mL (6 mL/kg IBW), PEEP 16, FiO2 1.0, RR 28. Plateau pressure is 41 cmH2O despite the low TV. Driving pressure is 25 cmH2O. PaO2/FiO2 is 55 mmHg. What does this combination of extremely low compliance, high driving pressure despite 6 mL/kg, and refractory hypoxaemia suggest?

Accepted Answer

The patient has an extremely small baby lung with very low recruitability - the functional lung is so small that even 6 mL/kg IBW causes dangerous strain; ECMO referral should be considered as conventional lung-protective ventilation cannot be delivered safely

Answer

The ventilator is malfunctioning

Answer

The PEEP is too high

Answer

The patient needs a larger tidal volume

Answer

This is a normal finding in ARDS

uk-fficm MCQ (SBA): ARDS - ECMO Referral