If a patient on VC has been suctioned and given albuterol but their PIP continues to rise, what should be done?

• A. Increase PEEP
• B. Decrease tidal volume
• C. Put Them in PC with a Decelerating Waveform
• D. Switch to CPAP

Answer: (C)

Rising peak inspiratory pressure on a volume-controlled vent usually signals increased airway resistance or decreased compliance, such as bronchospasm or secretions. After suctioning and bronchodilator treatment, if PIP remains high, the goal is to limit peak pressures while still delivering ventilation. Switching to a pressure-control mode with a decelerating waveform achieves this by setting a maximum inspiratory pressure, so the delivered pressure stays within safer limits, and the decelerating flow pattern helps improve gas distribution and reduce pressure spikes. Increasing PEEP would push pressures higher, decreasing tidal volume can risk under-ventilation, and CPAP wouldn’t provide the necessary mandatory breaths in a patient currently on controlled ventilation.