Which of the following techniques can help to decrease a patient's imposed work of breathing during weaning from ventilatory support?
1. Use of pressure-supported ventilation (PSV)
2. Trigger breath by flow, not pressure
3. Application of small amounts of continuous positive airway pressure (CPAP) or positive end expiratory pressure (PEEP)
4. Use of automatic tube compensation (ATC)
a. 2 and 4 only
b. 1, 2, and 3 only
c. 3 and 4 only
d. 1, 2, 3, and 4
ANS: D
The patient's ventilatory workload should be minimized with PSV. Flow trigger, flow-by, or ATC also may be helpful in minimizing imposed ventilatory work. Intrinsic PEEP during me-chanical ventilation may increase trigger work, and small amounts of PEEP or CPAP can help overcome this problem.
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