The hidden consequences of ventilator management decisions

Rolf D. Hubmayr, Richard A. Oeckler

Research output: Contribution to journalArticlepeer-review


In the following perspective, we will highlight seemingly remote, downstream consequences of common ventilator management decisions. For example, a change in PEEP may alter venous return, blood pressure, cardiac output, arterial and venous blood gas tensions, metabolic rate, respiratory sensations, breathing pattern, and the work of breathing. If providers consider any of these changes dangerous or maladaptive, they may initiate additional interventions in the form of vasoactive agents, intravenous fluids, and/or sedatives, all of which have their own risk/benefit profile. The approach to such co-interventions is rarely addressed even in well-designed large clinical trials. Therefore, it is often impossible to infer intervention-specific mechanisms of action and/or identify the phenotype of responders and nonresponders in such trials. On the flip side, in preclinical research intended to uncover mechanisms, experimental animals are rarely treated the way a critically ill patient would be. For respiratory therapists, this knowledge gap stresses the imperative to think beyond the lungs and to communicate ventilator management decisions with all members of the healthcare team.

Original languageEnglish (US)
Pages (from-to)1302-1305
Number of pages4
JournalRespiratory care
Issue number8
StatePublished - 2014


  • Adverse effects
  • Lung injury
  • Mechanical ventilation
  • Supportive care

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


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