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A COPD patient on volume assist-control has pH 7.31, PaCO2 68, intrinsic PEEP 12, set PEEP 5, RR 22, and frequent missed triggers. Which adjustment best addresses the asynchrony?
Increase sedation only and leave ventilator settings unchanged
Add inspiratory pause time to measure plateau more often
Increase the set rate to normalize PaCO2
Reduce dynamic hyperinflation and consider external PEEP below intrinsic PEEP
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