The numbers represent:

pH: 7.25 (7.35-7.45)

pCO2: 52 (35-45)

paO2: 70 (86-100)

HCO3: 24 (22-26)

You astutely realize that the pCO2 is elevated and the pH is decreased indicating a respiratory acidosis. You also notice that the paO2 is low. You know you can help by adjusting the ventilation and oxygenation, but how?!

Ventilation:

• It is the exchange of air between the lungs and the ambient air (air being delivered by ventilator) – moving air into and out of the lungs
• Primary way to remove CO2 (carbon dioxide) from the body is through ventilation
• Measure this with minute ventilation – as this can quantify the amount of CO2 being removed
• Minute Ventilation = respiratory rate (RR) x tidal volume (Vt)

For this patient, you can consider increasing the RR or tidal volume to help blow off more CO2 and improve the respiratory acidosis.

Oxygenation:

• Helps provide greater oxygen supply to the lungs, which then supplies more oxygen to the rest of the body
• Can increase the fraction of inspired oxygen (FIO2) or the positive end-expiratory pressure (PEEP)
• FIO2 is the percentage of oxygen mixed in the air delivered to a patient
• Normal FIO2 is 21%, whereas mechanically vented patients can get up to 100% oxygen
• PEEP is the positive pressure that remains in the lungs at the end of expiration (to help keep alveoli open)
• Starting PEEP is typically at 5 cm of H2O

For this patient, to improve oxygenation, you can consider increasing the FIO2 or PEEP depending on the current vent settings of this patient.

References:

Kaufman, D. (n.d.). Interpretation of Arterial Blood Gases (ABGs). Retrieved January 22, 2021, from https://www.thoracic.org/professionals/clinical-resources/critical-care/...

Mora Carpio AL, Mora JI. Ventilator Management. [Updated 2020 May 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448186/