Question: Answer The Following Questions In Regards To The Scenario. A Patient Is Admitted To The ICU With Severe Necrotizing Pancreatitis. A Few Hours After Admission, He Developed Increasing Oxygen Requirements And Was Intubated For Hypoxemic Respiratory Failure. Initially, His Oxygen Saturations Improved To The Mid-90% Range On An FIO2 Of 0.5, But In The Past …

Answer the following questions in regards to the scenario.

A patient is admitted to the ICU with severe necrotizingpancreatitis. A few hours after admission, he developed increasingoxygen requirements and was intubated for hypoxemic respiratoryfailure. Initially, his oxygen saturations improved to the mid-90%range on an F_IO₂ of 0.5, but in the past 2hours, the nurse has had to increase the F_IO₂back to 0.7 and his S_aO₂ is still in thelower 90% range. The patient remains on a PEEP of 5 cmH₂O. The nurse drew an ABG which shows pH 7.35,pCO₂ 38, PO₂ 60, HCO₃– 22 on anF_IO₂ of 0.8. The patient’s repeat chest -rayis shown below. An echocardiogram performed earlier in the dayrevealed normal left ventricular function.

CXR

QUESTIONS:

1. What is necrotizing pancreatitis?

2. How do you explain his worsening oxygenation status?

3. What other changes should you consider making in theventilator settings?

4. If his oxygen saturation fails to improve despite being onhigh levels of support (e.g. FiO2 1.0, PEEP 20 cm H20), what otheroptions do you, or the medical team, have for improvingoxygenation?