Auto-triggering of the ventilator is inappropriate triggering of ventilation when the patient is not attempting to initiate a breath
a type of ventilator-patient dyssynchrony
inspiratory triggers have been made more and more sensitive -> minimised extra-work
Flow distortions caused by:
high sensitivity settings
endotracheal cuff leaks
water condensation in the circuit
-> always consider patient actually breathing!
PRESSURE VERSUS FLOW TRIGGERING
flow trigger have a theoretical advantage over classical pressure triggers as that patient never has to breath against a closed circuit.
not documented in studies
hyperventilating patient (especially if heavily sedated)
significant air leak via ICC or circuit leak is present
condensation in the circuit
triggering matches ECG or SpO2 waveform
determine if patient truly breathing -> connect patient to a T-piece with capnograph and look for spontaneous breathing movements and a CO2 waveform
determine if the auto-triggering is due to cardiac oscillations -> evaluate if the ECG or SPO2 waveform matches triggering
to confirm that auto-triggering is occuring -> evaluate the Airway Occlusion Pressure at 0.1 second (P.01) -> if the P.01 is zero and the measured frequency is greater than the set frequency the ventilator is auto-triggering
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of two amazing children.
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