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Extra resources for ACCP Critical Care Medicine Board Review: 21st Edition
When high inspiratory effort continues during the ventilator-delivered breath, the patient may trigger a second, superimposed (‘‘stacked’’) breath (rarely a third, as well). Patient effort can be increased (if the goal is to exercise the patient) by increasing the magnitude of the trigger or by lowering VT (which increases the rate of assisting). Lowering f at the same VT generally has no effect on work of breathing when the patient is initiating all breaths. Synchronized Intermittent Mandatory Ventilation In the passive patient, SIMV cannot be distinguished from controlled ventilation in the ACV mode.
2008;299(6):637–645. Phoenix SI, Paravastu S, Columb M, Vincent JL, Nirmalan M. Does a higher positive end expiratory pressure decrease mortality in acute respiratory distress syndrome? A systematic review and meta-analysis. Anesthesiology. 2009;110(5):1098– 1105. Briel M, Meade M, Mercat A, et al. Higher vs lower positive end-expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome: systematic review and metaanalysis. JAMA. 2010;303(9):865–873. Talmor D, Sarge T, Malhotra A, et al.
HFOV Several modes of ventilation have in common the use of VT smaller than the dead space volume. Gas exchange does not occur through convection as during conventional ventilation, but through bulk flow, Taylor diffusion, molecular diffusion, nonconvective mixing, and possibly other mechanisms. Theoretical benefits of HFOV include the possibility to keep the lung open (recruited) while limiting overdistention, since tidal excursions are small. A substantial risk is that dynamic hyperinflation is the rule and alveolar pressure is greatly underestimated by monitoring pressure at the airway opening.