PMC9800186_01
Patient CT Chest.. CT chest showing usual interstitial pneumonia (UIP) pattern with subpleural reticular changes, traction bronchiectasis, and basilar honeycombing.
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A computed tomography (CT) scan of his chest compared to a previous CT showed stable, severe usual interstitial pneumonia (UIP) pattern consistent with his IPF (Fig. 1).
Initial Ventilator Settings and Peak Pressure.. The ventilator is set to volume control (VC)+ with a tidal volume of 480 mL. The patient is receiving 960 mL as seen at the top of the ventilator screen. Despite receiving this high tidal volume, peak pressure is normal at 18 cm H2O.
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Despite his severe pulmonary fibrosis, this high Vt only generated a peak pressure (Ppeak) of 18 cm H2O as captured by the ventilator (Fig. 2), while plateau pressure was 16 cm H2O.
PMC9800186_02
Adjusted Ventilator Settings and Effect on Peak Pressure.. The ventilator was adjusted to a lower tidal volume. However, the patient still received a significantly higher tidal volume. Peak pressure remained low at 18 cm H2O.
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Ventilator adjustments were trialed, with all showing normal peak pressure on the ventilator (Fig. 3).