You're listening to the podcast Surgery, I see Browns. My name is Jeff Guy.

I'm an associate professor of surgery at Vanderbilt University Medical Center and director of the Regional Burns Center there.

The topic that we're going to talk about today is the idea of patient ventilator interactions.

What does that mean? Well, again, we've talked about the idea that when somebody breathes,

they're interacting with the machine, and that we take for granted that since we do this commonly,

the magnitude of the insult that we're putting on the physiological system. We breathe by negative

pressure breathing. The ventilator is a positive pressure machine. And what we do is we think

that if we dial in a set frequency rate and total volume,

that that's all there is to do that, and we walk away, and we don't really look at how the

patient's interacting with the mechanical ventilator.

There's been a tremendous amount of research and a rapidly growing body of literature

that looks at things like delirium and sedation in the ICU.

Well, what do we do? A patient does not look comfortable on a ventilator. They're fighting or,

quote, bucking the ventilator. What do we do? Well, we naturally assume that we are inadequately

sedating the patient. So what we do is we snow the patient with more drugs like narcotics and

benzodiazepines. And then what happens is we take away all their will to breathe away,

and therefore they are on a mechanical ventilator because of our drugs, and then it turns into a positive feedback cycle, like a dog chasing the tail.

We had the patient mechanically ventilated, therefore we sedate them, we sedate them so much that they can't breathe,

and therefore we're required mechanically ventilate them.

And at some point, the cycle never, we have to try to break the cycle.

Now next time your patient is looking sedate or agitated or, quote, bucking the ventilator, what can we do?

Well, maybe we need to look at how the patient's interacting with the ventilator.

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