If a patient exhibits paradoxical chest wall motion, which of the following interventions is most appropriate?

• A. NIV with supplemental oxygen
• B. Intubate and use VC-CMV with PEEP
• C. Mask CPAP with supplemental oxygen
• D. Intubate and use PCIRV

Answer: (C)

Paradoxical chest wall motion typically indicates significant respiratory distress or failure, often associated with conditions such as flail chest or severe respiratory muscle dysfunction. In this context, the most appropriate intervention is mask CPAP with supplemental oxygen.

Using mask continuous positive airway pressure (CPAP) helps to stabilize the chest wall by increasing intrathoracic pressure, which can improve lung function and reduce the work of breathing. This approach can be particularly beneficial in cases where the patient is still able to breathe on their own, as it supports their respiratory efforts without the need for invasive measures like intubation.

Supplemental oxygen enhances oxygenation, addressing hypoxemia that may be present in these patients. This combination of CPAP with oxygen is effective for managing patients who exhibit paradoxical motion and can often lead to improved outcomes without the complications associated with more invasive forms of ventilation.

The other interventions, while they might be applicable in different scenarios, entail a higher degree of invasiveness or specific circumstances that may not be justified in all patients with paradoxical motion. For instance, intubation and controlled ventilation modes may be necessary for severely compromised patients, but they also carry risks and complications that might be avoided with non-invasive approaches like CPAP when possible.