Critical Care Scenarios Episode 10: Ventilator dyssynchrony
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Jun 28, 2020 Dive into the world of ventilator dyssynchrony with a case of a restless patient struggling during mechanical ventilation. Discover practical strategies for managing flow starvation and double triggering. Learn about adjusting pressure support for better patient-ventilator coordination and using the DOPES mnemonic for evaluating critical situations. The hosts also emphasize the importance of matching ventilator settings to patient needs and the essential role of respiratory therapists in this intricate dance of care.
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Match Ventilator Flow To Patient
- If a patient shows flow dyssynchrony, try switching from volume control to pressure support or pressure control to match the patient's flow.
- Increase fixed flow in volume control if needed, but prefer patient-focused modes to improve comfort and synchrony.
Fix Premature Cycling To Prevent Stacking
- For double triggering or breath stacking due to short inspiratory time, increase tidal volume or inspiratory time to match the patient's desired breath duration.
- Alternatively reduce patient's drive with sedation or move to pressure support and adjust cycling criteria to prolong breaths.
Recognize Reverse Triggering
- Reverse triggering is when a ventilator breath provokes a patient effort, often in deeply sedated patients.
- It can mimic double triggering but usually occurs in patients with low consciousness, requiring different management.