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A 45-year old male is receiving mechanical ventilation on the following settings:

Mode Assist/control Mandatory rate 16
Tidal volume 550 mL
FIO2 0.60
Pressure limit 60 cm H2O
PEEP 8 cm H2O
I:E 1:1.5
The patient is developing autoPEEP. The respiratory therapist should do which of the following?
A. Increase inspiratory flow rate
B. Decrease PEEP to 5 cm H2O
C. Discontinue PEEP
D. Set PEEP to match the Auto PEEP value

1 Answer

3 votes

Final answer:

Increasing the inspiratory flow rate is the correct response to mitigate autoPEEP in a patient on mechanical ventilation by ensuring a faster fill of the lungs and allowing more time for exhalation.

Step-by-step explanation:

A 45-year old male on mechanical ventilation is developing autoPEEP, a condition known as intrinsic PEEP or breath stacking, where the previous breath is not entirely exhaled before the next breath begins.

The respiratory therapist should counter autoPEEP to ensure proper ventilation and reduce the risk of barotrauma or hemodynamic compromise. To mitigate this, the correct approach would generally be to increase the inspiratory flow rate, which allows for a more rapid fill of the lungs and gives more time for exhalation. It is crucial in this situation to avoid increasing intrinsic PEEP and ensure complete exhalation before the start of the next breath.

Some other strategies could involve decreasing the respiratory rate or increasing the expiration time (I:E ratio), but those options are not listed. While adjusting the PEEP can be considered, simply decreasing it or discontinuing it might not be effective if autoPEEP is significant, and setting PEEP to match autoPEEP might not resolve the underlying issue of inadequate exhalation time.

User Lao Tzu
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