A 68-year-old patient with a history of severe chronic obstructive pulmonary disease (COPD) is intubated for acute respiratory failure. When setting the initial parameters for invasive mechanical ventilation, which of the following is the most critical consideration to prevent iatrogenic complications?
Maximizing tidal volume to rapidly reverse respiratory acidosis
Targeting a PaO2 level above 100 mmHg with a high FiO2
Allowing for adequate expiratory time to prevent air trapping
Using a high respiratory rate to normalize the PaCO2 level
In patients with severe obstructive lung disease like COPD, expiratory flow limitation can lead to air trapping (auto-PEEP) and dynamic hyperinflation. The most critical goal during mechanical ventilation is to allow for adequate expiratory time to minimize this risk. This is typically achieved by using a low respiratory rate and a low tidal volume (6-8 mL/kg of ideal body weight). Maximizing tidal volume or using a high respiratory rate would worsen air trapping and could lead to barotrauma and hemodynamic collapse. While adequate oxygenation is important, targeting supranormal PaO2 levels is unnecessary and can be harmful.
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BCEN CFRN
Resuscitation Principles
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