An intubated patient is receiving mechanical ventilation with the following settings: VC-CMV,rate = 18,Vᴛ = 850 mL (10 mL/kg),PEEP = 5 cm H₂O,flow rate = 40 L/min.The patient is sedated and is not assisting the ventilator.During a patient-ventilator system check,the respiratory therapist observes the following ventilator graphic:

The respiratory therapist should do which of the following?
A) Decrease the flow rate.
B) Increase the PEEP.
C) Decrease the rate.
D) Increase the Vᴛ.

Question

An intubated patient is receiving mechanical ventilation with the following settings: VC-CMV,rate = 18,Vᴛ = 850 mL (10 mL/kg) ,PEEP = 5 cm H₂O,flow rate = 40 L/min.The patient is sedated and is not assisting the ventilator.During a patient-ventilator system check,the respiratory therapist observes the following ventilator graphic:

The respiratory therapist should do which of the following?

The respiratory therapist should do which of the following?
A) Decrease the flow rate. 
B) Increase the PEEP. 
C) Decrease the rate. 
D) Increase the Vᴛ.

Quizplus · Accepted Answer

The figure clearly shows air trapping,as evidenced by failure of the expiratory portion of the curve to return to zero.Auto-PEEP should be suspected whenever flow does not return to baseline in the flow-volume loop.Efforts to reduce auto-PEEP can be aided by reducing the inspiratory time,minute ventilation,and Rₐᴡ.Decreasing the rate in this case would decrease the minute ventilation.Decreasing the flow rate would increase the inspiratory time,worsening the air trapping,and auto-PEEP.Increasing PEEP may make it easier for the patient to trigger the ventilator,but it would not reduce the air trapping.Increasing the Vᴛ would worsen the air trapping.

An Intubated Patient Is Receiving Mechanical Ventilation with the Following