For a near-drowning victim on mechanical ventilation who is hypercapnic, what should be done to ventilator settings?

In a near-drowning victim on mechanical ventilation who is hypercapnic, the appropriate response is to decrease the frequency of ventilation. Hypercapnia, or elevated carbon dioxide levels in the blood, often indicates that the patient is not adequately ventilating, which can occur in conditions such as pulmonary edema or compromised lung function common after a near-drowning event.

When you reduce the frequency of mechanical breaths, you typically allow for more time for exhalation, helping to improve the removal of carbon dioxide from the lungs. In such cases, maintaining a longer expiratory time can facilitate better gas exchange and decrease CO2 retention, addressing hypercapnia more effectively. Additionally, it may allow for better lung compliance and function, especially if the lungs are injured or filled with fluid.

While options like increasing the FiO2 or PEEP may be important in other contexts, these strategies do not directly tackle the underlying issue of hypercapnia. Increasing the FiO2 primarily targets hypoxemia (low oxygen levels) rather than hypercapnia, and while PEEP can improve oxygenation in cases of lung injury, it could also potentially impair CO2 elimination further if not carefully managed. Thus, the focus should be on adjusting the ventilation frequency to enhance removal of