A mechanically ventilated patient with COPD is receiving partial ventilatory support with PSV. The respiratory therapist notes a sudden rise at the end of each breath on the pressure-time graphic
What action should the respiratory therapist take at this time?
a. Change the mode to PRVC.
b. Change the mode to VC-CMV.
c. Lower the flow cycle setting.
d. Adjust the pressure support level.
ANS: C
Asynchronous breathing may be seen in patients with COPD when PSV is used. COPD patients often show active short inspirations and active long expirations. If the patient begins to exhale actively during the inspiratory phase of PSV, the flow may not drop to the necessary cycling value to end inspiration on the pressure-supported breath, resulting in a sudden rise in the scalar at the end of the breath. This problem can be prevented in these patients by using a ventilator with adjustable flow-cycling characteristics.
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