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Assembly

Not Enough

Authors
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 34 year old male with a history of portal hypertension presented with fever, change in mental status and hypotension. The patient was intubated for airway protection.

The current ventilator settings are Volume Controlled-Continuous Mandatory ventilation (VC-CMV) mode with RR 18/min, tidal volume of 460ml, a flow rate of 70L/min with a decelerating flow waveform and PEEP of 5cm H2O and FiO2 of 40%.

You observe the following flow and pressure waveforms (Figure 1)

Figure 1. Observed waveform showing signs of asynchrony
Figure 1. Observed waveform showing signs of asynchrony

Question

What form of patient ventilator asynchrony is clearly evident?

A. Delayed inspiratory cycling
B. Premature cycling
C. Ineffective Triggering
D. Auto Triggering

Answer