The therapist is delivering assist-control ventilation providing a constant VT to a patient experiencing ineffective triggering. The therapist also notes that expiratory flow fails to return to baseline before the initiation of the next mandatory breath. What should the therapist do at this time to correct this problem?
A. Increase the inspiratory flow.
B. Institute an inspiratory pause.
C. Conduct an expiratory pause maneuver.
D. Shorten the expiratory time.
?ANS: A
A. Correct response: This patient is receiving assist-control ventilation with a constant tidal volume and is experiencing ineffective triggering. By increasing the inspiratory flow, the expiratory time lengthens, and the dynamic hyperinflation and auto-PEEP decrease. Otherwise, the patient would be required to develop subatmospheric pressure equivalent to the sum of the applied PEEP and auto-PEEP to trigger inspiration.
B. Incorrect response: Instituting an inspiratory pause would aggravate the problem by lengthening inspiratory time further and shortening expiratory time. This situation would worsen the dynamic hyperinflation.
C. Incorrect response: Performing an expiratory pause maneuver would not rectify this situation.
D. Incorrect response: Shortening the expiratory time would worsen the problem by causing further dynamic hyperinflation.
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