The therapist is ventilating a patient with PSV. During the course of ventilation, the patient experiences periods of tachypnea, which cause variable inspiratory flows and changing inspiratory demands. How should the therapist resolve this situation?
A. Switch to airway pressure release ventilation.
B. Use automatic tube compensation.
C. Institute maximum minute ventilation.
D. Employ pressure control, inverse ratio ventilation.
?ANS: B
A. Incorrect response: Instituting airway pressure release ventilation at this time seems incongruous because these changing inspiratory demands caused by periods of tachypnea appear transient. No apparent need exists to establish two levels of supra-atmospheric pressure now.
B. Correct response: Automatic tube compensation (ATC) uses the known resistive characteristics of the patient's artificial airway to overcome the imposed work of breathing (WOB) caused by that airway. ATC is not a mode of ventilation. It is merely an add-on designed to eliminate the resistive characteristics of the artificial airway and the flow demand experienced by the patient. Choosing one level of PS is inadequate to meet the changing demands caused by variable inspiratory flows during tachypneic periods.
C. Incorrect response: MMV enables the patient to breathe spontaneously while, at the same time, ensuring that the patient receives a minimum minute ventilation.
D. Incorrect response: Inverse ratio ventilation would be a drastic measure at this time. No indication exists for establishing a prolonged TI with a shortened TE, which would elevate this patient's mean airway pressure.
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