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Internal Medicine

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65 years old with PMH of hypertension, diabetes, and congestive heart failure. He was admitted with increasing shortness of breath and had to be intubated for hypoxemic respiratory failure secondary to pulmonary edema. Ventilator screenshot is shown above. Notice the two inspirations without expiration in between in almost every breath on the ventilator.

How can you explain these findings on the ventilator?

  • 0%Double triggering

  • 0%Ventilator malfunction

  • 0%Reverse triggering

  • 0%Air leak

Please discuss or place any question in relation to this case in the comment section.

Great answers, indeed this is double triggering. Before I explain this fully, let me ask few questions  @Everyone

  1. what is the total inspired volume in the double triggered breath indicated with the yellow circle?

  2. why the pressure in the first inspiration of the triggered breath is decreased as indicated in the light blue arrow?

  3. Why the pressure in the second triggered inspiration is higher than the first triggered Inspiration indicated with the red arrow?

  4. What do you think the total exhaled air was in the exhalation indicated in the pink circle?

  5. How do you differentiate this from reverse triggering?

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