Conclusion

Now that you have reached the end of Chapter 6, you should understand spontaneous modes in much more depth, including when they are used. You should be able to describe pressure support ventilation (PSV) and understand why it is the most popular spontaneous mode—as opposed to a method like SIMV, which is mostly disused. Finally, you can describe the role of an SBT in weaning a patient off a ventilator.

Review

Please review the following key points from this chapter:

• Spontaneous modes are always used for patients who have a spontaneous drive to breathe
• Patient populations for which spontaneous modes are used include:
  • Tachypneic or tired patients that may require ventilatory support to unload their work of breathing, and
  • Patients who are weaning from the ventilator.
• PSV can range from 5-20 cmH₂0, and the setting is consistent for every breath unless changed by the health care professional.
• PS of approximately 5 cmH₂0 is considered to be “minimal settings.”
• An SBT is done to check if a patient is a candidate for extubation.
• An SBT is minimal Pressure Support and minimal PEEP.
• SIMV is no longer the “gold-standard” in weaning patients due to issues with asynchrony and increased work of breathing.