PRVC mode of ventilation with a targeted VT of 400, RR 26 and I:E ratio of 1:1.5. Notice the dynamic hyperinflation (autoPEEP) with persistent flow at end of expiration and the ineffective triggers.
Ventilator settings were adjusted to allow longer expiration by decreasing the rate to 20 per minute, and decreasing inspiratory time with I:E at 1:2.9. The volume was also increased to 450 ml.
Dynamic hyperinflation improved remarkably and now the ventilator is triggered with every inspiratory effort of the patient.
In the first setting of ventilator, there were two issues discovered
1) Auto Peep due to low expiration time, leading to air trapping- Auto Peep, by decreasing RR expiration time increased lead to resolved the auto peep issue as shown in second picture.
2) The second issue discovered what I observed was “ Air Hunger or Starvation ” in flow time waves, which was resolved by increasing Tidal Volume or Peak flow.
Thanks Dr. Mazen for sharing such interesting articles.