Clinicians’ Perspectives on “Fighting the Ventilator”

Introduction

“Fighting the ventilator” (FV) is characterized by a patient’s active counteraction of respiratory gas flow across multiple breaths during mechanical ventilation. An effective ventilation is prevented during such episodes. The objective of this exploratory study was to evaluate clinicians’ knowledge, perception and agreement regarding this condition.

Methods

In a cross-sectional online survey, medical professionals with experience in intensive care medicine (mostly neonatal and pediatric patients) responded to 11 questions covering various clinical aspects of FV.

Results

All respondents were familiar with the phenomenon and assessed it to be clinically relevant. Neonates were perceived to be predominantly affected. Promoting factors of FV included inadequate sedation and ventilation-associated factors. In clinical practice, the participants identified FV by clinical evaluation, analysis of ventilator waveforms and capnography and used both pharmacological and non-pharmacological intervention strategies. There was no consensus concerning the English terminology of the condition. Only few respondents were familiar with local guidelines to manage FV.

Conclusion

Although there was consensus on the relevance of FV, diagnostics and management strategies were highly heterogeneous. Many participants agreed that poor patient-ventilator synchrony was an important cause of FV. Future work should focus on characterizing and generating evidence on FV.

Impact

• „Fighting the ventilator” is a commonly known and frequent condition in mechanically ventilated patients and is a sign of patient distress.

• This survey conducted among highly experienced clinicians (from NICUs and PICUs) highlights the substantial lack in standardized terminology and management strategies.

• 82% of participants considered the phenomenon highly relevant, but reported heterogeneous approaches concerning its recognition and therapeutic intervention.

• The majority were unaware of local or international guidelines to guide the management of “fighting the ventilator”.

• Future work should address these knowledge gaps and unify terminology. We advise against the use of the unscientific violence metaphor “fighting the ventilator”.