What does the neonate/pediatric specialist recommend for a child on VC/SIMV ventilation who is facing increased breathing resistance?

In cases where a neonate or pediatric patient on volume control or synchronized intermittent mandatory ventilation (VC/SIMV) is experiencing increased breathing resistance, the implementation of pressure support ventilation is often recommended. Adding pressure support helps augment the patient's spontaneous breaths by providing a preset pressure assistance, which can reduce the work of breathing. This is particularly beneficial for patients struggling against increased resistance because it allows them to achieve better tidal volumes without having to generate significant effort themselves.

The addition of pressure support can improve ventilation efficiency and enhance comfort, particularly when a child is confronting situations that increase the load on their respiratory muscles, such as airway obstruction or overall lung compliance issues.

In contrast, increasing the tidal volume may inadvertently contribute to further respiratory distress, as it could lead to over-inflation and potential barotrauma, while increasing the respiratory rate might not effectively relieve the increased resistance and could cause discomfort. Adding PEEP could have various outcomes; while it can improve oxygenation by recruiting collapsed alveoli, it may also increase the work of breathing if the child is already struggling. Therefore, using pressure support is generally the most direct method to address increased breathing resistance in this context.