Vents 201 Part IV: Patient-Vent Dyssynchrony.

Sara Crager discusses patient-ventilator dyssynchrony, emphasizing its impact on hypoxemia and advocating for addressing it directly rather than relying solely on sedation. She uses the analogy of a relationship to describe the interaction between the patient and the ventilator, illustrating good and bad scenarios through waveform analysis and patient needs. Crager suggests starting with pressure support to understand the patient's breathing preferences, such as desired minute ventilation or inspiratory time, and adjusting ventilator settings accordingly. She addresses the complexities of managing patients with lung injury who desire high tidal volumes, and introduces APRV as a potentially comfortable alternative. Crager concludes by discussing the role of paralysis in severe cases, advocating for a thoughtful approach to sedation and paralysis to minimize negative side effects and improve patient outcomes.