What is the appropriate action for a patient with asthma on volume-controlled mechanical ventilation exhibiting autoPEEP?

In the scenario where a patient with asthma on volume-controlled mechanical ventilation is exhibiting autoPEEP, increasing the flow rate is the most appropriate action. AutoPEEP, or intrinsic PEEP, occurs when there is insufficient time for exhalation in patients with airflow limitation, such as those with asthma. This can lead to inadequate ventilation and patient discomfort.

By increasing the flow rate, you can shorten the inspiratory time, thereby allowing more time for exhalation. This helps to mitigate the effects of autoPEEP by reducing the overall duration of ventilation during each breath, thus allowing the lungs to empty more completely before the next breath is delivered.

The other actions, such as increasing PEEP, would likely exacerbate the situation by further trapping air in the lungs. Increasing FIO2 might improve oxygenation but wouldn’t address the underlying issue of autoPEEP. Similarly, increasing tidal volume could worsen barotrauma risks and may not effectively reduce autoPEEP. Therefore, increasing the flow rate is the most effective way to manage the autoPEEP in this situation, promoting better ventilation.