I have seen this not so infrequently.
What I see is pt is on PRVC (like every other patient) and is pulling in Tv of 600 to 700 when set at say 450 with peak pressures of 10 or so indicating that they are doing all the work. These are not necessarily patients with respiratory issues. For example the guy I have right now is intubated for airway protection. The solutions I see are
1. Knock him out, which I dont see the need for and can see being actually difficult at least to the level to get his TV down.
2. switch to VC but I usually see them still pulling excess TV
3. playing with Ti and peak flows and the TV usually haven't worked for me.
4. What I usually do is switch to pressure support which being flow cycled, I feel helps their work of breathing the best. However most attendings are uncomfortable with it and usually either disagree with me or just leave me to it.
I am just curious to see if I am wrong and if there are other solutions?
Thanks.
What I see is pt is on PRVC (like every other patient) and is pulling in Tv of 600 to 700 when set at say 450 with peak pressures of 10 or so indicating that they are doing all the work. These are not necessarily patients with respiratory issues. For example the guy I have right now is intubated for airway protection. The solutions I see are
1. Knock him out, which I dont see the need for and can see being actually difficult at least to the level to get his TV down.
2. switch to VC but I usually see them still pulling excess TV
3. playing with Ti and peak flows and the TV usually haven't worked for me.
4. What I usually do is switch to pressure support which being flow cycled, I feel helps their work of breathing the best. However most attendings are uncomfortable with it and usually either disagree with me or just leave me to it.
I am just curious to see if I am wrong and if there are other solutions?
Thanks.