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Respiratory Failure & Mechanical Ventilation

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Please notice the volume over time scalar as indicated by the light orange arrow and provide your feedback:

@Everyone


Please select your answer and you may provide your explanation in the comment section.

The noticed abnormality is caused by:

  • 0%Leak

  • 0%Auto-PEEP

  • 0%Malfunction

Please see comments for explanation!

I A
M S
Mazen Kherallah
Mazen Kherallah
Dec 02, 2023

So the main problem in the first breath is that the exhaled volume is less than the inhaled, then you would ask where did the air go, has it leaked or trapped, then if you look at the second breath, you see that the exhaled volume is more the than the inhaled indicating that the patient exhaled the trapped air from the first breath. The expiratory phase of the second breath is prolonged and patient had an inspiratory effort during it but was ineffective as he did not reach the trigger threshold.

Now, if this is trapped air in the first breath, why the flow did not persist at end of expiration? The answer is that he has a high central respiratory drive from massive stroke and his inspiratory efforts every 2 seconds cut off his expiratory flow and decreased to zero and in fact reached 3.66 L/min as you see at the dot and was able to trigger the ventilator for the second breath.

So this is trapped air or auto-peep.

here is what happened when I decreased the tidal volume to 450 from 540!


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