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Peak pressure apnea: An under-recognized, high-risk form of ventilator asynchrony

  • Author Footnotes
    1 Current address: 100 Hospital Drive, Farmington, CT 06030, United States.
    Brandon Oto
    Footnotes
    1 Current address: 100 Hospital Drive, Farmington, CT 06030, United States.
    Affiliations
    UConn Health, Adult Critical Care, Farmington, CT, United States
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  • Author Footnotes
    1 Current address: 100 Hospital Drive, Farmington, CT 06030, United States.
Published:February 10, 2020DOI:https://doi.org/10.1016/j.hrtlng.2020.01.012
      It has become clear that many critical care clinicians are unaware of a common and important variety of patient-ventilator asynchrony. This phenomenon has no name and is not described in textbooks, but might be denoted “peak pressure apnea.” All modern ICU ventilators have the ability to set an alarm for high peak inspiratory pressures, which can provide useful feedback in the event of circuit occlusions, mucus plugging, et cetera. However, on the majority of ventilators, this threshold functions not only as a passive alarm, but as a hard limit: once this number (or a value close to it) is reached, inspiratory flow will actually cease.
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