A lot of us are still trapped in the paradigms's of the past.

In the past ventilator triggers and response times were slow and sluggish. So flow triggering came along. But meanwhile the original problems with pressure sensitivity have been fixed (0.5 Pressure same as flow sensitivity). But RT's are still looking for the most sensitive and going there. I keep finding our LTV's, on adult patients, set at flow triggers of 2 or less.

Similarly original A/C breaths were sluggish and crude. Patients had to be sedated or given large VT's. So along came SIMV, then PS to augment the spontaneous breaths unsupported by nothing other than flow. But meanwhile the original problems of A/C have been solved. Now volume targeted (in PC/VC or VC itsslf) A/C is probably the best way to provide a "stable and non-fatiguing mode" for when patients fail their SBT. But instead they are placed on SIMV or PS and then that is "weaned" in parallel with daily SBT's. A recipe for continued fatigue masked by the mandatory breaths of SIMV....or PS just enough that their RR doesn't go over 30...instead it's 28 and they never sigh....look at P0.1 and it's 5.....

Well it seems to me most of the respondents forgot the original question. "Recently we have an anesthetist who sets the sens to the RED mark like oversensitive on the old vent. ---Question is this right?

As intuitive and dedicated RT's we dissect and delve into the small aspects of each setting to make sure where doing what's best for the patient.

How many Anesthetist and physicians have we worked with over the yrs that do things without any rhyme or reason. Your anesthetist is probably setting the sensitivity to the Red mark because that's what he's always done. Same reason why some place every patient on Peep of 5 and SIMV/VC. They are creatures of habit and asking yourself what they base there decisions on is the fastest way to drive you to a job in homecare ( Sorry no offence to home care providers)

Actually the original post ended in "please help me on learning more about flow trigger vs. pressure trigger." I think there were some very appropriate educational touchpoints discussed.

Nice to know that this thread has been revived. Note that i posted this July 2003. So many noteworthy comments were discussed and yes we still have to convince the MDs that were only after the patient's safety. To date, MD still sets the sensitivity to red and we RT constantly checks patients v/s and vent parameters to avoid any unfavorable outcome. On a personal note, yours truly got operated last December of 2006 (explorlap due to gallstone removal then led to liver bleeding) and got ventilated overnight with Dragger EXL. Close call, worthy experience thanks to MDs Nurses and RTs working hand in hand for patient's well being and safety.

ric here.

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