A 46-Year-Old Man Is Hospitalized with Severe Acute Pancreatitis

A 46-year-old man is hospitalized with severe acute pancreatitis.  Because of progressive respiratory difficulty, he is intubated and placed on mechanical ventilation.  His weight is 70 kg (152 lb) , blood pressure is 110/70 mm Hg, and heart rate is 90/min.  His respiratory rate is 18/min.  Chest x-ray shows patchy opacities bilaterally, consistent with pulmonary edema.  His current ventilator settings are: assist control mode, respiratory rate of 18/min, tidal volume of 450 mL, FiO2 of 40%, and positive end-expiratory pressure (PEEP) of 5 cm H2O.  His blood gas readings are: Which of the following is the best next step in managing this patient?

A) Bronchodilator therapy
B) Decrease FiO2
C) Decrease respiratory rate
D) Increase tidal volume
E) Incentive spirometry
F) Inotropic agents
G) Chest physiotherapy
H) Tracheostomy

Correct Answer:

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