Critical Care Scenarios

TIRBO #40: Ventilating the breathing patient

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Jul 26, 2023
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INSIGHT

Hybrid Nature of Ventilator Breaths

  • Patient breaths on ventilators combine ventilator-generated pressure and patient-generated muscular pressure (PMUS).
  • This hybrid mechanism creates challenges in managing ventilation for patients with spontaneous effort.
INSIGHT

Patient Drive vs Lung-Protective Ventilation

  • Strong patient respiratory drive often leads them to demand larger tidal volumes than ventilators set for lung protection.
  • This mismatch causes patient discomfort and ventilator desynchrony.
INSIGHT

Liberal Ventilator Settings for Comfort

  • Liberalizing ventilator settings to match patient demand can improve comfort and avoid desynchrony.
  • However, this may lead to non-lung-protective high tidal volumes that require clinical judgment.
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