Chose your answer and describe what you see and what you would do to correct it in the comment section!
We will post the answer later this week and describe how advanced monitoring with esophageal pressure can assist in interpreting waveform information.
10 thoughts on “What form of asynchrony do you see?”
Itsba reverse trigger , with some double trigger and brea Stacking
Reverse trigger, to know if there is any breathingstacking I have to see the volume curve. But the ventilator is not anticipating on the trigger. I would try to lower sedation if patient is stabile en oxygenation and ventilation are in a good range the acceptable pressures
I think you can assume by the flow waveform that the exhaled volume between the last two breaths is not the same.
Yes, that is true. But that looks like premature cycling and not a reverse trigger like the first three
Reverse triggering almost always shares visual criteria with premature cycling, but the patient did not trigger the breath, instead they began their effort at the very end of insufflation.
So of course the breath has cycled before the patient is done their effort, but that’s because their effort began at the very end of the machine breath. Premature cycling normally refers to a breath triggered by the patient that ends before the patient is done inspiring. The expiratory flow is similar, but the clinical picture is different.
You can see the full post now showing the esophageal pressure tracing.
This starts out looking like revers triggering however the efforts seem to be increasing in strength which I wouldn’t expect for reverse triggering. If it were reverse triggering I would need to know the pt.’s settings and VS to know whether to decrease sedation or muscle relax. The fourth breath is time cycled but the fifth is triggered with a larger exhaled Vt than the fourth but looks like a smaller inhaled Vt but doesn’t look like true breath stacking.