Adding pressure support ventilation is a suitable recommendation for improving comfort in a child who is in distress while on VC/SIMV (Volume-Controlled/Spontaneous Intermittent Mandatory Ventilation). Pressure support ventilation delivers a preset level of pressure during spontaneous breaths, which can help reduce the work of breathing by providing assistance whenever the child initiates a breath. This is particularly beneficial for a patient in distress, as it allows them to take breaths more easily and reduces the effort required to breathe through the endotracheal tube.
By increasing the pressure support, the immediate comfort level of the child can improve, as they receive additional respiratory assistance. This can help alleviate feelings of dyspnea or air hunger, supporting better overall oxygenation and ventilation.
In contrast, increasing the set rate or decreasing tidal volume may not directly improve comfort. An increased set rate could lead to a more labored breathing pattern and potential respiratory fatigue, while decreasing tidal volume may cause insufficient ventilation and dietary growth, which in turn can worsen the distress. Similarly, while increased PEEP can improve oxygenation in some situations, it may also make breathing more difficult for a child who is already in distress due to increased lung volume pressures, thereby negatively impacting their comfort level.