ABSTRACT
The term 'fighting the ventilator' is used to describe the situation where a mechanically ventilated patient is showing signs of agitation, with or without evidence of respiratory distress. This can happen when a patient becomes agitated, sedation levels fall or they try to breathe against the ventilator, also known as dyssynchrony. An immediate decision about the severity of the problem should be made. Hypoxia and hypercarbia are emergency situations and should be dealt with in a structured 'ABC' manner. If the patient is stable and there is no emergency treatment required, or once the patient has been successfully resuscitated, troubleshooting to identify the cause of dyssynchrony can commence. This can be divided into the following four broad areas: airway or breathing circuit issues, breathing or circulatory problems, inappropriate ventilator settings, and inadequate sedation or paralysis.
