What is the most likely form of asynchrony causing this waveform?
Voting has ended, view the full write up on Reverse Triggering.
This poll is no longer accepting votes
Posts
Copyright © 2023 The Toronto Centre of Excellence in Mechanical Ventilation
Podría tener alguna influencia el tipo de disparo escogido (flow or pressure) en el desarrollo o no de una “breath stacking” en el contexto de reverse triggering?
When the full article is posted you will see that the mode choice would not have made a difference whether breath stacking occurs unless an iTime of >2 seconds is used.
Lot’s of mess going on here. First, flow curve is zigzagging all over so I assume there is condensation in both inspiratory and expiratory hosing or/and endotracheal tube.
Second, we see the first breath occurring before total exhalation (flow doesn’t not return to zero). That could surely lead to overinflation, formation of autoPEEP and hence ineffective triggering seen right after the first breath.
Third delivered breath is triggered by “patient’s effort” (positive deflection in flow, negative in pressure), following mechanical breath so I suppose there’s a reverse triggering present.
Flow starvation. A longer inspiratory time will help.
It seems that diaphragm contractions are triggered by mandatory breaths. So, it is a reverse triggering.
Hay un ciclado precoz (1) que luego se convierte en un doble disparo (2).
1. se debe a un disbalance entre el tiempo inspiratorio mecánico y el tiempo inspiratorio neural, dado que el primero es más corto que el segundo.
2. la primer situación desencadena un evento en que el esfuerzo neural no es correspondido y el afán del paciente por completarlo hace que se venza el trigger y suscite una nueva respuesta sin haberse producido un tiempo espiratorio adecuado.