Set and don’t forget

Muhammad Sameed, Robert L Chatburn

Cite

Sameed M, Chatburn LR. Set and don’t forget. J Mech Vent 2023; 4(1):61-64.

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Abstract

52-year-old female with COVID-19 pneumonia and ARDS was intubated and placed on a Servo-U ventilator using Volume Control mode aiming lung protective settings. However, three hours after intubation, the patient’s ventilator waveform showed significant inspiratory effort, triggering the flow adaptation feature and switching the ventilator from volume control with constant flow to pressure control with variable flow. This dual targeting mode, called Volume Control with Flow adaptation, resulted in twice the tidal volume delivered to the patient and increased the risk of volumotrauma. The flow adaptation was subsequently turned off, and the sedation was adjusted to prioritize lung protection for the patient. This case highlights the importance of monitoring patient-ventilator interaction and choosing appropriate ventilator settings to prevent lung injury in patients with ARDS.

Keywords

ARDS, IMV, Volumotrauma, Flow adaptation

References

1. Chatburn RL, El-Khatib M, Mireles-Cabodevila E. A taxonomy for mechanical ventilation: 10 fundamental maxims. Respir Care. 2014;59(11):1747-63.
https://doi.org/10.4187/respcare.03057
PMid:25118309 
2. Chatburn RL, Liu PH. The evolution of intermittent mandatory ventilation. Respir Care 2023: 68(3):417-428.
https://doi.org/10.4187/respcare.10184
PMid:36195349 
3. Volsko TA, Hoffman J, Conger A, et al. The Effect of targeting scheme on tidal volume delivery during volume control mechanical ventilation. Respir Care. 2012; 57(8):1297-304.
https://doi.org/10.4187/respcare.01529
PMid:22348796 
4. Marini JJ, Rocco PRM, Gattinoni L. Static and dynamic contributors to ventilator-induced lung injury in clinical practice. pressure, energy, and power. Am J Resp Crit Care 2019; 201(7):767-774.
https://doi.org/10.1164/rccm.201908-1545CI
PMid:31665612 PMCid:PMC7124710 
5. Gattinoni L, Quintel M, Marini JJ. Volutrauma and atelectrauma: which is worse? Crit Care 2018; 22(1):264.
https://doi.org/10.1186/s13054-018-2199-2
PMid:30360756 PMCid:PMC6203268