Ventilator auto-triggering in a patient with tuberculous bronchopleural fistula.
We report a case of ventilator auto-triggering resulting from tuberculous bronchopleural fistula being managed with chest tube suction. Early recognition of bronchopleural fistula-related auto-triggering is extremely important. Auto-triggering can lead to serious adverse effects, including severe hyperventilation and inappropriate escalation of sedatives and/or neuromuscular blockers (administered to reduce spontaneous breathing efforts). Auto-triggering was confirmed in our patient when tachypnea persisted despite pharmacologic neuromuscular paralysis. Auto-triggering can be reduced or eliminated by decreasing ventilator trigger sensitivity or by decreasing the air leak flow by reducing the degree of chest tube suction.
Pulmonary, Allergy and Critical Care Division, Hospital of the University of Pennsylvania, 838 W Gates Building, 3600 Spruce Street, Philadelphia PA 19104, USA. jsager@mail.med.upenn.edu.
Jeffrey S
JS
Sager
Glenn
G
Eiger
Barry D
BD
Fuchs
D001983:Bronchial Fistula / Q000628:therapy*; D015505:Chest Tubes; D004868:Equipment Failure; D005260:Female; D005402:Fistula / Q000628:therapy*; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation; D008875:Middle Aged; D010995:Pleural Diseases / Q000628:therapy*; D011030:Pneumothorax / Q000517:prevention & control; D013396:Suction / Q000379:methods; D013990:Tidal Volume; D014397:Tuberculosis, Pulmonary / Q000150:complications*; D012122:Ventilators, Mechanical / Q000009:adverse effects*