What is the best initial action if a patient on mechanical ventilation is anxious and fighting the ventilator?

In situations where a patient on mechanical ventilation is anxious and fighting the ventilator, the best initial action is to verbally coach the patient to breathe with the ventilator. This approach engages the patient and helps them understand how to synchronize their breathing with the ventilator. By providing reassurance and encouragement, healthcare providers can reduce anxiety, improve the patient's comfort, and enhance the effectiveness of mechanical ventilation.

Verbal coaching can also allow the healthcare team to assess the underlying causes of the patient's anxiety, such as discomfort, fear, or misunderstandings about the ventilatory support. Establishing good communication with the patient facilitates cooperation and may resolve issues without needing immediate pharmacological interventions.

While sedation, manual ventilation, or adjusting infusions may be necessary in certain circumstances, they are typically responses to a situation already escalated beyond anxiety, potentially leading to further complications or delays in achieving patient comfort. Coaching provides a proactive, non-invasive solution that aligns with promoting the patient's autonomy and cooperation in their care.