The pressure-time scalar of a patient with COPD who is receiving PSV shows positive deflection toward the end of inspiration. The most appropriate way to alleviate this is to do which of the following?
a. Increase the PSV level.
b. Decrease the PSV level.
c. Increase the flow cycle percentage.
d. Decrease the flow cycle percentage.
ANS: C
This patient has cycle asynchrony. The positive deflection at the end of inspiration is caused by active exhalation. A patient with COPD needs a short inspiratory time and a long expiratory time. If the patient shows active exhalation before the end of inspiration, inspiration is too long. In PSV, inspiration ends when the flow cycle percent setting is reached. Increasing the flow cy-cle percentage will cause the ventilator to end inspiration earlier, thus allowing a longer time for expiration.
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