A 74-year-old man was intubated for hypercapnic respiratory failure 3 days ago. Past medical history

A 74-year-old man was intubated for hypercapnic respiratory
failure 3 days ago. Past medical history is significant for hypertension,
coronary artery disease, COPD, and former cigarette smoker ×35 years (quit 10
years ago). He is currently on low-level PSV (PSV 8, PEEP 5 cm H2O,
FiO2 0.3). Vital signs are heart rate 80 beats/min, blood pressure
130/70 mm Hg, respiratory rate 16 breaths/min, and SpO2 95%.
Endotracheal suctioning has been performed every 2 to 3 hours for moderate to
large amounts of yellow secretions. Ipratropium MDI, 2 puffs every 6 hours, is
ordered. He was placed on a spontaneous breathing trial this morning and
passed; however, his ability to clear secretions is a concern. After much
discussion among the patient care team, the decision was made not to extubate
as planned.

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