Work Shifting on PRVC (same as APV)

Detecting under-support from work shifting, and the options for shifting work back from the patient to the ventilator.

APVWork shiftingM2M5

Fig 1.This patient had severe ARDS and had signs of increased work of breathing with tachypnea and use of accessory muscles. She was being under supported by the ventilator. In addition, despite the appropriately set tidal volumes of 6ml/kg of predicted body weight, her actual tidal volumes were much higher, close to 9ml/kg. To better support a patient that is showing signs of work shifting, options include: 1) increasing set target tidal volumes to higher than what the patient is actually receiving so the ventilator must deliver additional pressure; 2) transitioning to a mode where work shifting does not happen (e.g., PC or PS where the ventilator will always give the same amount of pressure above PEEP regardless of patient effort); or 3) sedation with or without paralysis, so we shift the work back to the ventilator. In this case where limiting tidal volumes was paramount, only the third option was appropriate.

Learn the concept behind this case

Comprehensive · M2 — APV & work shifting

Comprehensive · M5 — Delivered vs. demanded support

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