Review Question - QID 212623

A 62-year-old man presents to the emergency department complaining of cough and chest pain. He states that the chest pain has been present for 2 weeks and worsens when he coughs. The patient has not been to a doctor in “years.” He denies tobacco use but admits to drinking 10 beers a day. He says he “shakes” in the morning before he has his first beer. A chest radiograph is obtained that is consistent with left-sided pneumonia. The patient is admitted for antibiotic treatment of pneumonia and for prevention of alcohol withdrawal with diazepam. On day 4 of his hospital course, the patient’s respiratory status worsens. The patient’s temperature is 100°F (37.7°C), pulse is 119/min, respirations are 30/min, and oxygen saturation is 76% on room air. On physical examination, the patient appears drowsy and dyspneic. He cannot speak in full sentences. Crackles are appreciated bilaterally, and intercostal retractions are noted. The patient is placed on mechanical ventilation with improvement of his oxygen saturation to 84%. A repeat chest radiograph is obtained, as shown in Figure A. Which of the following changes should be made next?