A patient on volume-control ventilation shows a decrease in static lung compliance and a high-pressure alarm is activated. Which action should the neonatal/pediatric specialist take?

• A. Increase the pressure limit
• B. Sedate the patient
• C. Decrease the tidal volume
• D. Decrease the flowrate

Answer: (A)

In volume-control ventilation, you’re aiming to deliver a set tidal volume. When static lung compliance falls, the lungs become stiffer, so the same tidal volume requires higher inspiratory pressure to push air in. If that pressure hits the ventilator’s limit, a high-pressure alarm sounds. To continue delivering the prescribed tidal volume, you need to raise the pressure limit so the ventilator can generate the needed pressure. Sedating won’t change the mechanics, and decreasing tidal volume would reduce the delivered volume, not address the issue. Adjusting the flow rate won’t reliably resolve the pressure required in stiffer lungs. Of course, you should also assess for reversible causes (airway obstruction, secretions, pneumothorax, edema) and monitor for barotrauma as pressures rise.