Autotriggering

One risk of the modern, highly sensitive, triggering systems is auto-triggering (Fig. 1). Transmission of cardiac oscillations in terms of flowor pressure can be sufficient to trigger the ventilator, and can result in dangerous hyperventilation in a sedated or even paralyzed patient [11]. Through a better control of expiration, inspiratory triggers have been made more and more sensitive to minimize the extra-work due to the triggering mechanisms. Among the new sensitive systems, whether some systems are less prone than others to self-triggering has not been well addressed yet, though could have important clinical consequences [12]. Clinicians should seek for self-triggering especially in case of hyperventilation. Oscillation of resident water in the ventilator circuit can also be responsible for self-triggering.

Mechanical Ventilation

Fig. 1. Auto-cycling occurs when non respiratory airflow or pressure oscillations or leaks mimic an inspiratory effort. These tracings show airway pressure (Paw) and flow; the first cycle is triggered by the patient, as evidenced by a negative airway deflection, whereas the two following cycles do not show any evidence of patient activity (auto-cycling).

Fig. 1. Auto-cycling occurs when non respiratory airflow or pressure oscillations or leaks mimic an inspiratory effort. These tracings show airway pressure (Paw) and flow; the first cycle is triggered by the patient, as evidenced by a negative airway deflection, whereas the two following cycles do not show any evidence of patient activity (auto-cycling).

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