A 26-Year-Old Man Is Being Evaluated in the Intensive Care

A 26-year-old man is being evaluated in the intensive care unit 24 hours after he was admitted with acute respiratory distress syndrome due to opioid overdose and aspiration of gastric contents.  The patient is intubated, sedated, and receiving mechanical ventilation.  The patient had anesthesia-induced hypotension after intubation, but has been hemodynamically stable after receiving 4 L of normal saline.  Temperature is 38.1 C (100.6 F) , blood pressure is 118/78 mm Hg, pulse is 96/min, respirations are 20/min, and oxygen saturation is 92%.  The patient is receiving low tidal volume ventilation at 8 mL/kg ideal body weight, FiO₂ is 50%, and positive end-expiratory pressure is 12 cm H₂O.  The patient-ventilator interaction is synchronous.  Arterial blood gas analysis demonstrates pH 7.31, PaCO₂ 50, and PaO₂ 64.  Chest x-ray shows patchy bilateral opacities consistent with pulmonary edema.  Echocardiography shows normal left ventricular function.  Which of the following interventions would be most helpful to promote recovery of the patient's respiratory failure?

A) Avoiding a positive fluid balance to reduce pulmonary edema
B) Increasing tidal volume to avoid "permissive" hypercapnia
C) Raising FiO₂ to keep oxygen saturation ≥96%
D) Maximizing airway pressure to hyperinflate the lung
E) Providing continuous sedation to maintain deep coma

Correct Answer:

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