Pressure Support Ventilation is one of the most commonly used modes of assisted ventilation during the weaning phase. In patients who are recovering from the acute phase of both obstructive and restrictive lung diseases, monitoring respiratory effort and the total pressure distending the respiratory system is of invaluable help in order to maintain a “protective”…

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Reverse triggering is a type of dyssynchrony that occurs when a patient effort occurs after (‘is triggered by’) the initiation of a ventilator (non-patient triggered) breath.  Usually, it is a phenomenon occurring over many consecutive breaths and also referred to as ‘entrainment’. Diagnosis The visual detecting of reverse triggering is slightly different between modes of…

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What is the most likely form of asynchrony causing this waveform? Voting has ended, view the full write up on Reverse Triggering.

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Bedside Mechanical Ventilation Rounds are an excellent way to strengthen clinical knowledge of the subject. In this post we describe the rounds and provide tips for implementation in your institution.

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Case vignette 56 yo gentleman recovering from severe ARDS, muscle paralysis was discontinued 24hrs ago. Still on continuous sedation with Propofol and Midazolam. Clear “asynchrony” on the ventilator with frequent double cycling. Oxygenation has worsened in the last 6 hours. You go to the bedside and find: What maneuver can help you understand the underlying…

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Expiratory flow limitation (EFL) is often associated with the presence of auto-PEEP. There are simple bedside maneuvers that can be done to determine the severity of EFL. For this subject, the CoEMV invited Detajin Junhasavasdikul MD, first author of a paper on the subject published in Chest, 2018.

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The results are in!   There were multiple correct responses.  The patient indeed has high resistance as shown by the large difference between peak-inspiratory pressure (PIP) and plateau pressure (Pplat).  They also have significant expiratory flow limitation as suggested by the shape of the expiratory flow-time curve (methods for assessing EFL will be included in another…

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Flow starvation is a form of patient-ventilator dyssynchrony that occurs when a patient is demanding more flow than the ventilator provides.

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