A 63-year-old man with multiple rib fractures and a pulmonary contusion requires prolonged intubation. He is unable to be weaned from the ventilator and is on a volume control mode. He has a tracheostomy and a percutaneous gastrotomy in place through which he is being fed. The surgeon orders a respiratory quotient (RQ), which is the ratio of the rate of carbon dioxide production over the rate of oxygen uptake. The RQ is 1. Based on this information, which of the following is the next step in his management?
Correct Answer: Decrease the carbohydrates in his enteral feeds
Description: The respiratory quotient (RQ) is the ratio of the rate of carbon dioxide production over the rate of oxygen uptake. An RQ of 0.75 to 0.85 is ideal. The RQ is dependent on the composition of nutritional suppo. An RQ of 0.7 indicates a diet comprised largely of lipids. An RQ of 1 or greater indicates a diet comprising primarily carbohydrates, which can impair weaning from the ventilator. Decreasing the carbohydrates in the enteral feeds would facilitate the patient's ventilator wean. Changing ventilator settings by decreasing the inspired concentration of oxygen or the rate may be indicated as pa of the ventilator wean, but these will not affect the RQ.
Category:
Anaesthesia
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