What would be the appropriate initial ventilator settings for a patient admitted after a left pneumonectomy with no spontaneous respirations?

• A. VC, SIMV, rate 12, FIO2 1.0, VT 650 mL, PEEP 5 cm H2O
• B. VC, A/C, rate 16, FIO2 1.0, VT 275 mL, PEEP 5 cmH2O
• C. PC, SIMV, rate 8, IP 34 cm H2O, I-time 1.0 sec, FIO2 0.5, no PEEP
• D. VC, SIMV, rate 10, FIO2 1.0, VT 500 mL, PEEP 5 cmH2O

Answer: (B)

The choice of initial ventilator settings for a patient who has undergone a left pneumonectomy and has no spontaneous respirations must prioritize adequate ventilation and oxygenation while being mindful of lung mechanics and compliance.

The selected option emphasizes volume control (VC) with assist/control (A/C) mode, set to a rate of 16 breaths per minute. This setting ensures that the patient receives a certain number of breaths at a pre-determined tidal volume, which can be critical for maintaining adequate ventilation in a patient lacking spontaneous breaths. Importantly, the tidal volume is set at 275 mL. This is a reasonable volume considering the reduced lung capacity following pneumonectomy, as excessive tidal volumes can lead to barotrauma, especially in the remaining lung.

The setting of an FIO2 of 1.0 indicates complete oxygen delivery, which is appropriate given the potential for significant hypoxemia immediately following such a procedure. Moreover, the use of PEEP (positive end-expiratory pressure) at 5 cm H2O helps maintain alveolar recruitment and improve oxygenation without adding excessive pressure that could jeopardize the remaining lung’s function.

This set of conditions takes into account the balance of adequate ventilation, reduced risk of lung injury, and