Approach to acid-base disorders Quiz: Ace Your Exams

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A 68-year-old man with interstitial lung disease is admitted to the intensive care unit for severe pneumonia. On admission, the patient is intubated and placed on mechanical ventilation. On the second day of hospitalization, the patient appears restless and diaphoretic. Temperature is 38.3 °C (101.0 °F), heart rate is 108/min, respiratory rate is set on the ventilator, blood pressure is 100/65 mmHg, and oxygen saturation is 95% on FiO₂ of 60%. Physical examination reveals diminished breath sounds and bilateral crackles in the lower lung fields. A morning arterial blood gas analysis is shown below. Which of the following ventilator settings is most likely contributing to the patient’s laboratory findings?

Test	Result
pH	7.50
PaCO₂	28 mm Hg
HCO₃-	22 mEq/L

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High positive end-expiratory pressure (PEEP)

High fraction of inspired oxygen (FiO₂)

Low tidal volume

High respiratory rate

Low inspiratory flow rate