This intubated patient is being ventilated in PSIMV+ mode. What kind of asynchrony is visible in the breath marked by the cursor?
Answer: What you can see here is delayed cycling. The ventilator’s mechanical inspiratory time exceeds the patient’s neural inspiratory time. In this case, delayed cycling is indicated by distortions in both the flow and pressure waveforms at mid-inspiration (~ 7 sec.). The flow curve shows a change in slope towards the baseline, indicating an abrupt relaxation of the inspiratory muscles. At the same time, the pressure curve shows a slight peak.
In this patient, the delayed cycling occurred during a mandatory breath.
Possible solutions are:
- Shorten the set TI to match the patient’s neural TI.
- Activate Psync to allow the patient to control his TI via flow-cycling at every breath. The set rate will function as a backup rate.
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