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Respiratory Failure & Mechanical Ventilation

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hi dr. Mazen I need your input regarding this Q , from SEEK 2021 Critical Care Medicine

You are asked to review the following ventilator graphics. Which combination of ventilator mode and patient-ventilator asynchrony is displayed in Figure 1? A. Pressure support (PS) ventilation (PSV) with evidence of ineffective trigger asynchrony B. PSV with evidence of double-trigger asynchrony C. Synchronized intermittent mandatory ventilation (SIMV) with volume control breaths plus PS and evidence of double-trigger asynchrony D. SIMV ( volume control breath Plus PS) with evidence of ineffective trigger asynchrony

Mazen Kherallah
Mazen Kherallah
Jun 09, 2022

All the breaths are triggered by the patient as indicated by the pink color on the pressure/time curve. The fifth breath is ineffective in triggering the ventilator. The pressure seems to be limited in the 1st, 2nd, 3rd, 4th, and 6th breaths. The cycling mechanism seems to be the flow at about 20% of the peak inspiratory flow. Note the variable inspiratory time, flow, and inspiratory volumes in all these breaths. All these indicate that these breaths are pressure supported, and the mode is PSV with evidence of ineffective trigger asynchrony. These is no evidence of volume controlled breaths or double-trigger asynchrony.

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