A patient with acute respiratory distress syndrome (ARDS) has developed a pneumothorax from elevating peak and plateau pressures
The patient is currently being ventilated in the volume-controlled continuous mandatory ventila-tion (VC-CMV) mode with a set rate of 12 breaths/min. However, the patient is triggering the ventilator at a rate of 25 breaths/min. The arterial blood gas reveals ventilator-induced hyperven-tilation with corrected hypoxemia. The most appropriate recommendation to manage this patient on the ventilator is which of the following?
a. Sedate the patient.
b. Decrease the set ventilator rate.
c. Switch the mode to pressure-controlled intermittent mandatory ventilation (PC-IMV).
d. Switch the mode to pressure-controlled continuous mandatory ventilation (PC-CMV).
ANS: C
Switching to pressure-controlled ventilation will reduce the continued risk of alveolar overdisten-tion, which has already caused a pneumothorax, by limiting the amount of positive pressure ap-plied to the lung. Using the intermittent mandatory ventilation (IMV) mode will decrease the ability of the patient to cause ventilator-induced hyperventilation by triggering mandatory breaths. IMV, with a low ventilator rate setting, can very well reduce this patient's respiratory alkalosis. Using pressure support with the pressure- controlled intermittent mandatory ventilation (PC-IMV) mode will decrease the WOB for the patient during spontaneous breaths.
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