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Assembly

An Equal and Opposite Reaction

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.

Ventilator Readings

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

Answer