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Fig. 1 | Intensive Care Medicine

Fig. 1

From: Reverse triggering in a patient with ARDS

Fig. 1

From top to bottom, recording of flow, esophageal pressure (Pes), and airway pressure (Paw) over time during mechanical ventilation in volume controlled mode with the following settings: constant flow inflation 0.71 L/s, tidal volume 0.340 L, respiratory rate 24 breaths per minute, inspiratory time 0.60 s. All mechanical breaths but one are followed by downward deflection of esophageal pressure (vertical continuous lines). None of mechanical breaths is triggered by the inspiratory effort of the patient, but rather each mechanical breath triggers esophageal pressure. The rate of set breathing frequency at the ventilator and that of peak-to-peak esophageal pressure (horizontal double arrowed lines) are equal (24 breaths per minute). For the third breath, the oesophageal pressure is in phase with airway pressure (vertical dotted arrowed line) and its morphology is in accordance with chest wall inflation. It should be noted that peak Paw was a bit high (38 cm H2O), while plateau pressure of the respiratory system amounted to 23 cm H2O. Therefore, the main reason for peak Paw is increased resistive pressure due to high inspiratory flow. It would be important in further cases to look at the effect of changing inspiratory flow, and hence Paw on the occurrence of reverse triggering

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