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Reverse Triggering

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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Expiratory Flow Limitation (EFL)

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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Interpret This Waveform Pattern

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

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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Short Cycling

Short cycling is a common form of patient-ventilator dyssynchrony. It occurs when a patient-triggered breath cycles off prior to the patient effort being completed.

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Ineffective Efforts

Ineffective efforts are one of the most common forms of patient-ventilator dyssynchrony.  They occur when the patient is unable to trigger the ventilator during the expiratory phase of ventilation.

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