Changes to Ventilation: The Goals

As clinical providers, remember our guiding goal is to decrease the trauma of ventilation. We have discussed the impacts that mechanical ventilation can have on the lungs—application of positive pressure and the risk of VILI, barotrauma and volutrauma (see Chapter 5). Also, we have discussed the concerns of respiratory muscle atrophy if the patient is on the ventilator for too long (see Chapter 6). The best paths to minimizing these negative effects are

  • tailoring the ventilation settings to match your patient’s needs, and
  • shortening the duration of mechanical ventilation and decreasing settings as quickly as possible.

These two guiding considerations need to be at the forefront of all approaches to ventilation. As a clinician, we need to ensure we are correcting issues with mechanical ventilation, but also, when able, constantly moving to decrease ventilation settings and progress our patients towards extubation. But, don’t forget: you cannot push towards extubation until the patient’s presenting issue is resolving and the arterial blood gases (ABGs) are corrected.

Key Concept

The goals of making changes to mechanical ventilation are:

  1. Correcting imbalances or issues in the body—often seen on ABGs
  2. Progressing the patient towards extubation via decreasing settings, moving to spontaneous modes or getting to minimal settings
A health care professional is suctioning a patient's mouth prior to extubating them. The patient's eyes are taped shut and they are wearing a hair net, so they are in the operating room.
Now that their surgery is complete, this OR patient is being suctioned prior to extubation.

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