Case 1 - "Bucking the Vent"

You have inherited a patient in the VA MICU at signout.  The patient presented with spontaneous bacterial peritonitis and altered mental status and was intubated for airway protection and hypoxic/hypercarbic respiratory failure.  The patient’s altered mental status has resolved but the patient remains intubated waiting for a second large-volume paracentesis that can’t be done over the long weekend at the VA. The RT calls you asking for a one time dose of 5mg Versed, but on a quick glance at the chart, the patient has been getting these Q2 hours for the last several days.  You go to the bedside and find an agitated patient motioning to take out the tube.  “He’s bucking the vent doc!”

Vent settings: AC-VC: TV500  RR12  PEEP8  FiO2 30%