A 45-year-old male with morbid obesity (BMI 55) presents to…

A 45-year-old male with morbid obesity (BMI 55) presents to the ED at 6 AM with right leg pain, and cellulitis that has kept him awake all night. He is admitted to the ward and his fevers and skin examination are improved with antibiotics during the first 16 hours of hospitalization. At 2 AM you are called to evaluate the patient for ICU admission because of somnolence and hypoxemia (SpO2 falling to high 70s on 2LNC). The rapid response team had difficulty waking the patient and ABG was performed before your arrival in the patient’s room: 7.29/74/52. Following arterial puncture, the patient woke up and by your arrival he is able to converse but remains sleepy with eyes closed, denying dyspnea, with SpO2 now 92% on 2LNC, and normal work of breathing. Medication history was reviewed, and no opiates have been administered. The ward team is requesting ICU transfer because of acute hypercarbic respiratory failure and initiation of BiPAP. You review recent laboratory test results and note that serum bicarbonate has been 38 to 40 over the last 6 months.Which of the following statements is true?

A 38-year-old, 155 cm, 50 kg, previously health female prese…

A 38-year-old, 155 cm, 50 kg, previously health female presents to the ICU with altered mental status, tachycardia, hypotension, and high fever. She is intubated for airway protection. Her laboratory test results reveal a markedly elevated T3 and T4 level with a decrease in thyroid-stimulating hormone level consistent with thyroid storm. Her arterial blood gas shows a pH of 7.24, PaO2 of 80, PaCO2 of 52, and HCO3 of 22. Her ventilator settings are volume control, tidal volume of 350 mL, respiratory rate of 14, positive end expiratory pressure (PEEP) of 5, FiO2 of 50%. Which of the following is the next appropriate step in management?