Failure to maintain sats on ventilator

[nurseJinicu]

Has anyone ever had or heard of a patient who was unable to be properly oxygenated/ventilated on a ventilator? I recently had a patient who could not maintain oxygen saturations above 80-85 on a ventilator-- with the RT trying every possible setting and combo. Pt had to be emergently intubated post thoracotomy and BPs were in 70s before pressors and ended up on an extreme amount to keep pressures up.

I just wondered if anybody could share some light on this and what might have made the patient so hard to oxygenate/ventilate. Im guessing it was a result of true cardiogenic shock but I'm not sure.

[jenvankempen]

I once had a patent ion a vent post huge PE. She ended up going into ARDS. She was on 100% oxygen and a peep of 25 I believe. And even then it still looked as if she was gasping for air. We had we on 4 pressers and even that was barely breaking the 90s systolic. She ended up passing. But this was a patient that was kept alive for family and had to work pretty hard to die. Before this patient I had never seen agonal breathing on a vent, especially at 100%. Crazy!

[Sun0408, ASN, RN]

I've seen it many times, mostly related to ARDS. I've also seen it in TBI'S or massive head bleeds. When I see agonal breathing or guppy breathing on a vent, I get nervous. The end results are usually not good. I have also seen what you describe post code, this pt was on very high amounts of peep and 100% FIo2, maxed on several pressors as well as an insulin gtt...

[meanmaryjean, DNP, RN]

The vent can only do so much.

[umcRN, BSN, RN]

All the time in peds, then we start talking about oscillating or ecmo if that doesn't work, depending on what the issue is.

Of course I work cardiac so sometimes our normal sats are in the 70's :)

[meanmaryjean, DNP, RN]

All the time in peds, then we start talking about oscillating or ecmo if that doesn't work, depending on what the issue is.

Of course I work cardiac so sometimes our normal sats are in the 70's :)

I'm imagining all the adult ICU nurses swooning right now over the thought of a patient whose sats are ALWAYS in the 60s-70s! :) When nurse visitors come to our PICU we get some 'aren't you going to DO anything?' looks when they see our monitors!!

[umcRN, BSN, RN]

I'm imagining all the adult ICU nurses swooning right now over the thought of a patient whose sats are ALWAYS in the 60s-70s! :) When nurse visitors come to our PICU we get some 'aren't you going to DO anything?' looks when they see our monitors!!

My favorite was a few weeks ago had a kiddo who all day had been fine (pre op TGA, sats 80's) and then around 5pm apparently the PFO started closing and he wanted it in a bad bad way. Sats 30's, lost IV access, me practically banging on the doctors head to get him to realize this was a problem. Kiddo had an emergent BAS that night, got his sats right back to the 70's where we wanted them

[meanmaryjean, DNP, RN]

We have a kid currently who is an accomplished breath-holder. He can get to 42% before he passes out and gets back into cruising range. The rule is, "Do NOT **** this kid off!" because he is un-baggable when he is mad. Little stinker.

[umcRN, BSN, RN]

We have a kid currently who is an accomplished breath-holder. He can get to 42% before he passes out and gets back into cruising range. The rule is, "Do NOT **** this kid off!" because he is un-baggable when he is mad. Little stinker.

Oh yes, we have our fair share of those too. Wait till they pass out then bag em up

[Penelope_Pitstop, BSN, RN]

All the time in peds, then we start talking about oscillating or ecmo if that doesn't work, depending on what the issue is.

We do those things in adults, also...very very rarely. But they usually don't end well. Lately there's been a proning trend. Haven't seen that end well, either.

[ICUPrincessNurse]

When they're like that we start looking at HFOV and rotoprone. Usually doesn't end well. BUt I'm a believer in the proning. IF anything is going to work- it will.

[TraumaSurfer]

Too bad this RT did not suggest another ventilator like even the HFOV and maybe nitric oxide long before now. FAIL. The RT should have been calling his medical director to get advice on getting the best equipment for this patient.