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Ventilator auto-triggering in a patient with tuberculous bronchopleural fistula
Jeffrey S Sager1, Glenn Eiger, Barry D Fuchs
1Pulmonary, 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.
Abstract:
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.