For a patient with ARDS receiving volume-controlled ventilation, what should the respiratory therapist recommend based on the provided data?

• A. Increase PEEP to 25 cm H2O
• B. Switch to pressure-control ventilation
• C. Increase mandatory rate to 22
• D. Increase VT to 500 mL

Answer: (B)

In a patient with Acute Respiratory Distress Syndrome (ARDS) who is undergoing volume-controlled ventilation, switching to pressure-control ventilation is a well-considered recommendation. This method allows for better protection of the lungs from potential overdistension and barotrauma, which is particularly important in ARDS management.

Pressure-control ventilation enables the operator to set a maximum pressure for each breath, which ensures that the tidal volume delivered doesn’t exceed lung compliance limits. In ARDS patients, lung compliance is often decreased, meaning that high volumes can lead to further injury. By utilizing pressure control, the respiratory therapist can better tailor the ventilation strategy to avoid causing additional damage to already compromised lung tissue.

Furthermore, transitioning to pressure-control settings can facilitate improved oxygenation and ventilation by allowing for more flexible adjustment of inspiratory time and flow patterns, which are beneficial in optimizing patient-ventilator synchrony and overall respiratory function.

The other options, such as increasing the PEEP to a very high level or increasing tidal volume and mandatory rate, might not be appropriate as they can escalate peak airway pressures or worsen patient-ventilator synchrony, further complicating the management of ARDS.