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Ramping Position to Aid Non-invasive Ventilation (NIV) in Obese Patients in the ICU

Mohamed Shirazy
Mohamed Shirazy
, 
Christopher Gowers
Christopher Gowers
 e 
Padraig Headley
Padraig Headley
   | 08 feb 2023
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Article Category: Case Report
Pubblicato online: 08 feb 2023
Pagine: 43 - 48
Ricevuto: 23 apr 2022
Accettato: 06 dic 2022
DOI: https://doi.org/10.2478/jccm-2023-0002
Parole chiave
© 2023 Mohamed Shirazy, Christopher Gowers, Padraig Headley, published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Fig. 1

Chest X-ray of Case 1: Bi-basal atelectasis and small bilateral pleural effusion.
Chest X-ray of Case 1: Bi-basal atelectasis and small bilateral pleural effusion.

Fig. 2

Chest X-ray of Case 2: Hazy opacification of both lungs’ mid and lower zones. Infection versus congestion.
Chest X-ray of Case 2: Hazy opacification of both lungs’ mid and lower zones. Infection versus congestion.

Fig.-3

Case 2 on NIV lying on Oxford HELP pillow. The external auditory meatus (Line A) and the sternal notch (Line B) are aligned.
Case 2 on NIV lying on Oxford HELP pillow. The external auditory meatus (Line A) and the sternal notch (Line B) are aligned.

Fig. 4

Case 2 lying at 30 degrees up of the thorax. The external auditory meatus (line A) and the sternal notch (Line B) are not aligned.
Case 2 lying at 30 degrees up of the thorax. The external auditory meatus (line A) and the sternal notch (Line B) are not aligned.

Medications for Case 1.

Medication Dose and route Duration
-Co-amoxiclav 1.2 g Intravenous twice daily 3 days
-Clarithromycin 500 mg Intravenous twice daily 3 days
-Doxycycline 100 mg Oral twice daily 4 Days
-Pantoprazole 40 mg Intravenous once daily 5 days
-Prednisolone 30 mg Oral once daily 5 days
-Enoxaparin 40 mg Subcutaneous once daily 5 days
-Amlodipine 5 mg Oral once daily Regular medication
-Paracetamol 1g Intravenous every 6 hours 5 days
-Oxycodone 2.5 mg Oral every 4 hours 5 days as per request
-Salbutamol 5 mg nebuliser every 6 hours 5 days
-Ipratropium Bromide 500 mcg nebuliser every 6 hours 5 days

ABG, Blood results, and ventilation of Case 2

Admission After ramping 12 hrs 24 hrs overnight Day 3 Day5
ABG*
PH 7.17 7.22 7.43 7.46 7.44 7.43
PCO2** (Kpa) 15.3 13.2 8.6 8.6 8 7.6
PO2*** (Kpa) 26.8 10.9 14.9 9.5 8.9 11.7
HCO3**** (mmol/l) 31.5 31.7 36.6 39 35.5 33.6
Lactate (mmol/l) 0.8 0.8 1.3 0.8 1.2 1.1
Ventilation
Oxygen delivery NIV mask Drager Evita V800 NIV mask Drager Evita V800 Face mask NIV mask Drager Evita V800 Nasal cannula Room air
Ventilator mood BIPAP BIPAP BIPAP
Airway adjunct Natural Natural Natural Natural Natural Natural
FIO2***** 100 % 60 % 40% 40 % 24 % 21%
PEEP****** (cmH2O) 5 5 7
Pressure support (cmH2O) 25 25 14
Actual tidal volume (ml) 170 507 480
Peek inspiratory pressure (cmH2O) 39 26 27
Respiratory rate 38 29 22 18 20 22
WOB scale 6/7 5/7 2/7 1/7 1/7 2/7
Blood results
Haemoglobin (g/l) 118 106 112 116
Leukocytes (x10 g/l) 15.9 9 9.8 10.2
Platelets (x10 g/l) 368 302 299 296
C-Reactive Protein (mg/l) 76.2 52.8 26.7 26.2

ABG, Blood results, and ventilation of Case 1

Admission After ramping 12 hrs 24 hrs Day 3 Day 5
ABG*
PH 7.15 7.28 7.46 7.43 7.42 7.41
PCO2** (Kpa) 16.9 10.9 7 7.1 7.5 7.4
PO2 ***(Kpa) 9.5 9.7 9.2 8.5 8.9 8.3
HCO3**** 30.8 31.3 33 31.8 32.2 32.4
(mmol/l)
Lactate (mmol/l) 1.1 0.9 1.3 1.5 0.8 1.1
Ventilation
Oxygen delivery NIV mask Drager Evita V800 NIV mask Drager Evita V800 NIV mask Drager Evita V800 Nasal cannula Nasal cannula Room air
Ventilator mood BIPAP BIPAP CPAP
Airway adjunct Naso-pharyngeal Naso-pharyngeal Naso-pharyngeal Natural Natural Natural
FIO2***** 40% 40% 30% 36% 32% 21%
PEEP****** (cmH2O) 8 8 8
Pressure support (cmH2O) 23 23 N/A
Actual tidal volume (ml) 125 428 538
Peek inspiratory pressure (cmH2O) 42 24 23
Respiratory rate 42 28 22 20 18 17
WOB scale 6/7 4/7 2/7 1/7 1/7 1/7
Blood results
Haemoglobin (g/l) 172 165 170 168
leukocytes (x10 g/l) 13.2 11 7.8 8
Platelets (x10 g/l) 169 195 209 218
C-Reactive Protien (mg/l) 54 22.6 17.5 11.4

Medications for Case 2.

Medication Dose and route Duration
-Co-amoxiclav 1.2 g Intravenous twice daily 5 days
-Clarithromycin 500 mg Intravenous twice daily 5days
-Pantoprazole 40 mg Intravenous once daily 5 days
-Prednisolone 30 mg Oral once daily 5 days
-Enoxaparin 80 mg Subcutaneous once daily 5 days
-Furosemide 40 mg Intravenous twice daily 4 days
-Salbutamol 5 mg nebuliser every 6 hours 5 days
-Ipratropium Bromide 500 mcg nebuliser every 6 hours 5 days
eISSN:
2393-1817
Lingua:
Inglese
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4 volte all'anno
Argomenti della rivista:
Medicine, Clinical Medicine, Anaesthesiology, Emergency Medicine and Intensive-Care Medicine, Internal Medicine, other, Surgery
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