Impact of Sedation on Work Shifting
How patient effort can mask poor mechanics on an adaptive mode — revealed once sedation removes the effort.
Patient with ARDS being ventilated on APV. Note on the right lower corner that the ventilator was delivering only 3cmH2O above PEEP with each breath (Pinsp), under supporting this patient, who had clear signs of increased work of breathing on physical exam. The low airway pressures seen here could mislead one to think that respiratory system mechanics were normal. P.S. You may need to close the captions to see the Pins in the right lower corner
After sedating the patient and taking away their inspiratory effort, note how the amount of pressure delivered by the ventilator to achieve the target volumes increased remarkably. Nothing changed with the patient’s respiratory system other than removing their inspiratory effort, which was masking their poor mechanics. P.S. You may need to close the captions to see the Pins in the right lower corner, which has increased from 3 to 24cmH2O
