The sign-out: asthmatic patient, failed bipap, intubated, bilateral pneumonia / ARDS, admitted to micu. This is her cxr. What do you do?

Jacobi / Montefiore Emergency Medicine Residency
The sign-out: asthmatic patient, failed bipap, intubated, bilateral pneumonia / ARDS, admitted to micu. This is her cxr. What do you do?

I’m starting by unhooking the vent and letting the pt exhale. I count almost 12 ribs on that X-ray.
Im also changing vent settings allowing for a longer E:I ratio.
As for the ARDS portion it’s tough to put a high peep on a tight asthmatic so I would start at 5 and adjust as tolerated (watching pressures and volumes)