Additional Case of Early Trigger Highlighting the Principles of Treatment of this Dyssynchrony

A second early-triggering case reinforcing the core principle of treatment — letting the patient initiate their own breaths.

APVPSVEarly triggerM1M5⤢ before / after

Problem.Double triggering (breath stacking) with patient-triggered (marked with purple arrowhead) breath following every ventilator-triggered breath. We call "early triggering" this pattern in which a ventilator trigger event shortly precedes inspiratory effort. This pattern has led to the hypothesis that lung insufflation by the ventilator is responsible for the initiation of inspiratory effort by the patient, hence this patient-ventilator interaction is also referred to as "reverse triggering" (the ventilator "triggers" the patient).

Fix #1

Note how double triggering only occurs after ventilator-initiated breaths (first set of breaths). Double triggering due to early triggering does not happen if the patient initiated the breath (last few breaths) - early triggering is the phenomenon in which the ventilator triggers the breath before the patient starts exerting inspiratory effort. This observation highlights the basis of treatment of this dyssynchrony: allowing the patient to initiate their own breaths. We can accomplish this by decreasing sedation and decreasing the rate/switching mode to pressure support. If these are not possible (e.g., severe ARDS), we may need to increase the depth of sedation or even paralyze the patient if we want to suppress early triggering.

Fix #2