Patients that require ventilation support generally suffer from insufficient oxygenation of blood and tidal volume inside lungs. Moreover, respiratory disorders, prior history of lung and brain injury and accumulation of secretions in lungs also affect the oxygen intake capacity of the patients. In some critical cases where inspiration and expiration time of breathing fails to match, breaths get accumulated in the lungs of the patients. This phenomenon generally seen in ventilated patients is called breath stacking.
In this article we will unleash what exactly breath stacking is and what its shortcomings and consequences are.
What is Breath Stacking
Breath stacking takes place when ventilator dependent patients receive additional breath before exhaling the previous one. It generally occurs when following breath is initiated before providing adequate time to patient’s lung to exhale the last one. The breaths that fail to get out of the lungs start stacking on one another resulting in increased end-expiratory pressure.
Being a threat to the comfort of the patient and capable of producing critical outcomes, it is important for professionals to understand this occurrence and take special measures to avoid serious outcomes.
Dangers of Breath Stacking in Ventilated Patients
Breath stacking if not timely observed and managed can cause serious damage to the health of the patient. The patient can face certain complications if not evaluated properly.
Here is a list of traumas and health threats that patients pass through after breath stacking.
- Patient feels uneasiness while breathing and may suffer from increased load of breathing, shortening of breath or even breathlessness.
- Increased pressure inside lungs can result in barotrauma which ultimately can damage the lungs of the patient.
- Breath stacking has the potential to compromise the cardiac output of the patient as well. The elevated intrathoracic pressure results in decrease in blood flow as well as poor perfusion.
- Breath stacking may induce a complication named VILI, ventilator induced lung injury, in patients dependent on mechanical ventilation. It can lead to serious lung damage, especially in patients with some prior history of lung conditions.
How to Prevent Breath Stacking in Ventilated Patients
The professionals providing health care to the ventilated patients need to go extra mile to avoid breath stacking and complications associated with it.
Here is a list of precautions that can reduce the chance of breath stacking in ventilated patients.
- Adjustment of apt expiratory time can serve as a good measure to prevent breath stacking.
- The health professionals need to adjust necessary breathing parameters including respiratory rate, tidal volume and IE ratio (inspiratory-expiratory ratio) as per the needs of the patient.
- Ventilators work in different modes which are adjusted as per the condition and the requirement of the patient. The right selection of mode can help in lowering the chances of breath stacking in ventilated patients.
- Ventilated patients on continuous sedation may feel comfort but at the same time sedation can affect the inhale-exhale balance and can lead to breath stacking. An adequate level of sedation can help to avoid breath stacking in such critical patients.
- Continuous check on the patient’s health status as well as responses is important to determine and address any traces of breath stacking timely.
Summary
In a nutshell, breath stacking in ventilator dependent patients is somehow a complex issue that needs special attention and call of action from the health care providers. It is crucial to control breath stacking to avoid complications and improve overall lung health of the patient. Keen observation and appropriate patient management along with right ventilator settings can add much to the effective prevention of breath stacking. It is best practice to individually treat every patient and underline their respiratory needs to provide safe ventilation and avoid breath stacking.
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