A patient with decreasing pulmonary compliance is on volume-controlled ventilation with an I:E ratio of 1:2 and shows increased atelectasis. What change should be made for this patient?

In the context of a patient with decreasing pulmonary compliance who is experiencing increased atelectasis during volume-controlled ventilation, modifying the inspiratory flow rate can be beneficial. By decreasing the inspiratory flow rate, you extend the time that gas is being delivered to the lungs during inhalation. This results in a longer inspiratory time relative to the total breath cycle, which can help improve gas distribution throughout the lungs, particularly in areas that are potentially at risk for atelectasis.

In patients with altered lung mechanics, such as those with decreased compliance, the time available for gas exchange is crucial. A longer inspiratory time facilitates better uptake of oxygen and improves ventilation in poorly compliant regions of the lungs. This adjustment can also allow for a more gradual inflation of the alveoli, reducing the risk of barotrauma or over-distension in already compromised lung areas.

When considering the ventilatory parameters for a patient with decreased compliance, creating a suitable I:E ratio and ensuring adequate time for both inspiration and expiration is key to optimizing respiratory mechanics and improving overall pulmonary function. Therefore, decreasing the inspiratory flow rate effectively addresses the issue of increased atelectasis in this scenario.