In a message dated 9/11/99 1:21:26 AM Eastern Daylight Time,
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Dear Nilima,
Regarding your patient in the ICU who has HR fluctuations with PT and is on
volume control - yes, I believe there is no problem with asking her to take
"deep breaths", but I think that while on volume control, deep breaths
probably won't be any more efficient than the volume that is set. On the
other hand, what may be more effective is to speak with the physicians
regarding temporarily changing her over either pressure control or pressure
support with settings to provide greater than routine tidal volumes as set
with volume control. You can also as the patient becomes stronger, ask them
to increase the sensitivity of the ventilator so that she is working harder
to trigger the device. Finally, you may wish to talk to them about using an
inspiratory pause during your PT sessions. Some ventilators have this
option, which I think would be similar to a 'breath-hold', which is used in
so many techniques at this time.
Hope these ideas may be of some assistance,
Craig Lapin, M.D.
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