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.
Sager
Jeffrey S
JS
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.
Eiger
Glenn
G
Fuchs
Barry D
BD
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*