The therapist is managing a patient who has been reestablished on mechanical ventilation after failing SBTs. How should the therapist manage the aspect of respiratory muscle loading for this patient?
A. Provide the patient with a comfortable level of assisted ventilation.
B. Sedate the patient and provide controlled mechanical ventilation.
C. Gradually decrease the level of ventilator support before the next SBT.
D. Progressively increase the level of ventilatory support before the next SBT.
?ANS: A
A. Correct response: An important consideration regarding a patient recommitted to ventilatory support is whether the level of support should be decreased over time. Doing so has been the traditional approach in terms of ventilator weaning. This approach has been based on the notion that progressive loading of the respiratory muscles would hasten the transition to unassisted spontaneous breathing. However, no data support the notion that loading recovering respiratory muscles above that required for breath triggering and comfort provides a physiologic benefit. The recommendation is to set a comfortable level of ventilatory support, and then adjust it if the patient's condition worsens.
B. Incorrect response: See explanation A.
C. Incorrect response: See explanation A.
D. Incorrect response: See explanation A
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