In managing a child on mechanical ventilation in the Assist/Control, Volume Control mode, how should the specialist increase minute ventilation?

Increasing minute ventilation in a child on mechanical ventilation in the Assist/Control, Volume Control mode is best achieved by increasing the mandatory rate. Minute ventilation is calculated as the product of tidal volume and the respiratory rate. In this mode, the ventilator automatically delivers a set tidal volume at a specified rate. By increasing the mandatory rate, more breaths are delivered per minute, which directly increases the overall minute ventilation.

While adjusting the tidal volume would also effectively increase minute ventilation, the question specifically addresses managing ventilation through changes in the ventilator settings. Increasing the mandatory rate is a straightforward method to enhance ventilation without altering each individual breath size.

Other options, such as increasing the FiO2 or PEEP, address oxygenation and maintaining end-expiratory lung volume but do not directly increase the amount of air the child receives per minute. Similarly, adjusting the I:E ratio impacts how long the child spends in inspiration versus expiration but does not contribute to an increase in the total minute ventilation unless it affects the overall frequency of the breaths, which is indirect. Therefore, increasing the mandatory rate is the most effective and immediate way to achieve the desired increase in minute ventilation in this scenario.