Failed Triggering and Detecting Airway Resistance

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Matt Siuba
Zentensivist. ARDS, Mechanical Ventilation, RV, & Shock Enthusiast.

The Pre-brief

Did you know that the most common ventilator dyssynchrony doesn’t even cause the ventilator to alarm? 

How do you detect and treat failed triggering (ineffective triggering)? Watch the video for details!

The De-brief

  • Failed triggering is common, with the most concerning cause being high airway resistance and intrinsic PEEP
  • Understanding expiratory flow waveforms and the time constant can help treat resistance and intrinsic PEEP
  • NAVA is an alternative mode of ventilation which can be used to avoid this particular dyssynchrony
  • For more on detecting whether airway resistance is an issue, view these posts by Aman Thind and Komal Parikh on airway pressures.

References

  1. Pham T, Telias I, Piraino T, Yoshida T, Brochard LJ. Asynchrony Consequences and Management. Crit Care Clin. 2018;34(3):325-341. doi:10.1016/j.ccc.2018.03.008
  2. Chatburn RL, Mireles-Cabodevila E. 2019 Year in Review: Patient-Ventilator Synchrony. Respir Care. 2020;65(4):558-572. doi:10.4187/respcare.07635

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