Double-triggering seen in flow and volume waveforms from volume-controlled ventilation. Continued subject effort during the second breath causes the airway pressure to drop below the trigger threshold, which initiates an additional “stacked” breath. Note the large increase in peak airway pressure caused by the stacked breath and the high peak expiratory flow following the stacked breath.
No difference in hypotension or SOFA between Ketamine and Etomidate RSI:
In a single-center study comparing the effects of ketamine and etomidate during Rapid Sequence Intubation (RSI) on critically ill adults, 143 patients were evaluated for the highest SOFA scores and incidence of hypotension post-intubation. The results revealed similar outcomes for both drugs: median SOFA scores were 6.5 for ketamine and 7 for etomidate, with hypotension rates at 28% and 26%, respectively. The thirty-day mortality rates were 11% for those administered ketamine and 21% for etomidate, though the difference was not statistically significant. Thus, both agents showed comparable effects on SOFA scores and hypotension rates in the studied population.
Cycling asynchrony on the ventilator assessed by expiratory muscle EMG (Transversus abdominis):
The above graph shows the relationship between the flow over time waveform and the activities of the expiratory muscles measure by EMG. The relationship of neural expiratory time to ventilator expiratory time was assessed by measuring the phase angle, expressed in degrees. If neural activity began simultaneously with the ventilator, the phase angle (0) was zero. Neural activity beginning after the offset (termination) of inflation by the ventilator resulted in a positive phase angle (60 degrees for subject 1). Neural activity beginning before the offset of inflation by the ventilator resulted in a negative phase angle (45 degrees for subject 2)
