Author
Siddharth Dugar, MD
Critical Care Fellow, Cleveland Clinic, OH
Robert L. Chatburn, MHHS, RRT-NPN, FAARC
Professor, Department of Medicine
Lerner College of Medicine of Case Western Reserve University
Case
Consider a 45 year old male with severe ARDS secondary to H1N1 influenza intubated for hypoxic respiratory failure. He is sedated to RAAS of -4 due to ventilator asynchrony.
His Ventilator settings are Pressure control A/C with RR 22/min, PEEP 8, FIO2 40%, Inspiratory time of 0.85 sec, Pressure rise time of 60% and inspiratory pressure of 12 cm H2O above PEEP.

Question
What patient ventilator asynchrony is observed in the following Pressure/time and Flow/time waveforms?
A. Delayed cycling
B. Premature cycling
C. Reverse triggering
D. Double triggering