Case Study 3

Female. 47 years-old. Acute hypoxia. Morbid obesity. 

A 47-year-old, morbidly obese female with cellulitis to her left lower extremity was transferred to a Level 1 Trauma Center from an outside hospital. Prior to her emergent transfer the patient had become acutely hypoxic and required intubation with maximal ventilator settings. Upon arrival she had an oral temperature of 102.3 with Acute Respiratory Failure along with the following co-morbidities:

  • Left Lower Extremity Cellulitis

  • Bilateral Opacities/ ARDS

  • Sepsis

  • Non-oliguric Acute Kidney Injury

  • HTN

  • Morbid Obesity

  • Elevated Troponin

  • Possible Pulmonary HTN

  • Possible combined systolic and diastolic CHF

 

The patient was admitted to the ICU, orally intubated and ventilated on ACVC settings with 100% FIO2, and on Nitric Oxide. She was continuously agitated and unable to wean off sedation, therefore a tracheostomy was placed nine days after admission to help ease weaning from ventilator and sedation.

 

During her hospital course the patient was placed on intermittent hemodialysis due to acute tubular necrosis from sepsis, rhabdomyolysis, and hypoxia. 

Special Care Unit

The patient was accepted to our unit for aggressive ventilator weaning two weeks after her admission to the ICU. Her ventilator settings:

  • Mode:  ACVC

  • Ventilator Rate:  16

  • FIO2:  75%

  • Tidal Volume:  360

  • PEEP:  8

 

The patient received quality high-touch nursing care along with comprehensive treatment modalities from Respiratory Therapy, Physical Therapy, Occupational Therapy, and Speech and Language Pathology. She was successfully weaned from in just thirteen days, de-cannulated ten days later, and discharged only one day after de-cannulation. Upon discharge the patient was able to perform bed mobility, transfers and ambulate 20 feet with a rolling walker and supervision.