65-year-old male with the past medical history of CAD s/p DES in proximal RCA, COPD, DM type 2 was admitted for acute exacerbation of COPD and pneumonia requiring intubation with mechanical ventilation.
On third day he had significant improvement with Rapid Spontaneous Breathing Index of 75 so spontaneous breathing trial was initiated. Before the trial was started his BP was 130/86mm Hg, Pulse 85bpm, Respiratory rate 20 per minute. After 20 minutes of trial he became tachycardia to 140 with VT of 10 sec, BP increased to 180/100mm Hg and Respiratory Rate increased to 36 per minute.
Which of the following is the most appropriate management?
- Extubate now to high flow oxygen
- Treat patient with IV metoprolol for non-sustained VT and hypertension
- Continue the intubation and try Spontaneous breathing trial next day
- Consult cardiology for non-sustained VT and hypertension.
Answer: 3
Discontinuing mechanical ventilation is a two-step process: Readiness testing and the weaning. RSBI (f/VT) gives information about the readiness. RSBI 30s) or continued to be hypertensive and having frequent VT then we can consider further intervention.