A 35-Year-Old Man Is Found Unresponsive in a Parking Lot

A 35-year-old man is found unresponsive in a parking lot with syringes and drug paraphernalia next to him.  Emergency medical personnel administer naloxone and intubate the patient for airway protection.  On arrival at the emergency department, health care providers begin mechanical ventilation in assist control mode; tidal volume is 500 mL, respiratory rate is 10/min, fraction of inspired oxygen is 40%, and positive end-expiratory pressure is 5 cm H₂O.  Physical examination reveals an unresponsive patient with sluggish pupils.  His blood alcohol level is elevated, and urine drug screen is positive for opioids and benzodiazepines.  CT scan of the head shows no acute findings.  The patient is admitted to the intensive care unit for further management.  An arterial blood gas obtained an hour later reveals the following: Which of the following is the most appropriate next step in management of this patient?

A) Decrease tidal volume
B) Increase fraction of inspired oxygen
C) Increase positive end-expiratory pressure
D) Increase respiratory rate
E) Maintain current ventilator settings

Correct Answer:

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