I just wanted to know if there is a difference when you put a patient of pressure support of zero and peep of zero compared to just putting the patient on trach collar instead...does it make a difference and if so in what way?

They might be.

Sometimes when a patient is on the vent, PS and Peep both zero, some ATC (Automatic Tube Compensation) or TC (Tube Compensation) is set. This takes the entered ET tube or trache, looks at patient flow demand, and does give pressure support. With an ET tube this makes some sense, but with a trache it's totally ridiculous as the trache won't be "removed" before the patient is liberated from the ventilator.

The other aspect is what sensitivity is set on the ventilator vs. having the trache collar flow be right there. We have one MD whom is always turning the pressure sensitivity to negative 3, I think because she confuses it with the 840's Flow trigger setting. One the other hand an overly sensitive setting can trigger on cardiac oscillations. For a patient truly on PS zero this wouldn't really hyperventilate but might give you a RR readout which would falsely elude to them having a rapid shallow pattern.

In addition all the alarms going off (sometimes signifying nothing) could generate a vicous cycle (Pavlovian as patient would remember that sound associated with suction, perhaps tube occlusion, etc.) and cause needless patient anxiety and deterioration.

The good thing about having the patient on the vent is the alarms IF something goes wrong. A double edge'd sword.

Bottom line for me..try it on the vent. But if the patient fails miserably don't hesitate to go to trache collar.

For a deeper (and more partisan pro trache collar mist over using the ventilator) find Martin Tobin's AARC conference lecture. It was several years ago, was published in Respiratory Care journal. It was the Donald Egan lecture I recall.