Changing ventilator graphics in a patient with massive cerebral hemorrhage.

A 56-year-old woman with poorly controlled hypertension presented to the emergency department with aphasia, right-sided weakness, and an arterial blood pressure of 250/130 mm Hg. A computed tomography scan revealed a large left-sided cerebral hemorrhage. The patient’s neurologic condition worsened and she was intubated and mechanically ventilated (7200 ventilator, Puritan-Bennett, Pleasanton, California). On hospital day 3 her ventilator settings were: continuous mandatory ventilation mode, frequency 12 breaths/min, tidal volume 600 mL, fraction of inspired oxygen (FIO2) 0.35, peak inspiratory flow 70 L/min with a decelerating flow pattern. During a routine ventilator check the peak inspiratory pressure was 15 cm H2O and the total respiratory frequency was 18 breaths/min. The pressure/time and flow/time curves from the ventilator’s graphic monitor were unremarkable (not recorded). A few minutes later the low inspiratory pressure limit (set at 10 cm H2O) alarmed; a quick inspection revealed no circuit leaks or disconnection. Figure 1 shows the ventilator’s pressure/time and flow/time curves during that situation. The curves in Figure 2 were recorded 5 minutes after those in Figure 1.