In order for TGI to be safely administered it must interface with the mechanical ventilator . As indicated earlier, expiratory TGI eliminates problems with increasing Vt and plateau pressure during TGI. Appropriate system monitoring should be available, including measurement of total PEEP, peak inspiratory pressure and Vt. To insure patient safety, a method of identifying increased carinal pressure and deactivating the TGI system if an obstruction occurs must be incorporated into any TGI system. The TGI system must be appropriately humidified, not an easy task because of the small diameter ofTGI catheters. Up to 15 psi driving pressure is required to establish a flow of 8 l/min though a 1 mm internal diameter TGI catheter . Few humidifiers are designed to withstand this type of pressure. If patients are breathing spontaneously, TGI interferes with ventilator triggering. As a result, precise timing of activation and deactivation of the TGI system is critical.
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