Mechanical Ventilation Modes

A 68-year-old man with COPD is intubated in the ICU for acute hypercapnic respiratory failure. He is currently on volume-controlled ventilation (VCV) with a tidal volume of 8 mL/kg ideal body weight, respiratory rate 16/min, and FiO₂ 0.6. His ABG shows pH 7.28, PaCO₂ 58 mmHg, PaO₂ 85 mmHg, and HCO₃⁻ 26 mEq/L. Peak inspiratory pressure is 42 cm H₂O. He is triggering the ventilator appropriately and is on minimal sedation. What is the most appropriate next step in management?

A 52-year-old woman with acute respiratory distress syndrome (ARDS) secondary to pneumonia is on volume-controlled ventilation with a tidal volume of 6 mL/kg ideal body weight, respiratory rate 18/min, PEEP 10 cm H₂O, and FiO₂ 0.8. Current ABG: pH 7.32, PaCO₂ 52 mmHg, PaO₂ 78 mmHg, HCO₃⁻ 24 mEq/L. Peak plateau pressure is 28 cm H₂O. She is adequately sedated and paralyzed. What is the most appropriate next step in management?

A 58-year-old male with COPD exacerbation is intubated in the ICU. On day 2, he is on volume-controlled ventilation with a tidal volume of 8 mL/kg, rate 14/min, and PEEP 5 cm H₂O. ABG shows pH 7.28, PaCO₂ 58 mmHg, PaO₂ 85 mmHg on FiO₂ 0.6. The patient is triggering the ventilator 22 times per minute but only 14 breaths are being delivered. He is fighting the ventilator and sedation has been optimized. Which ventilation mode would be most appropriate to reduce patient-ventilator dyssynchrony and allow spontaneous breathing?

In pressure-controlled ventilation (PCV), which parameter is directly controlled by the ventilator?

Which ventilation mode allows the patient to breathe spontaneously at their own rate while the ventilator provides a preset pressure support with each breath?