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Cardiogenic-Auto-Triggering-as-a-Consequence-of-He (1)
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The document is a case report about a 70-year-old woman who experienced hemorrhagic shock due to hemoperitoneum following a paracentesis, leading to complications while on mechanical ventilation. Despite no spontaneous breathing, her ventilator displayed increased respiratory rates on its settings, and she developed respiratory alkalosis. The clinicians discovered that cardiogenic oscillations were auto-triggering the ventilator, an issue resolved by conducting a large-volume paracentesis. This highlights a phenomenon known as cardiogenic auto-triggering, where the heart's movements during its cycle can unintentionally initiate ventilator breaths. This can result in patient-ventilator dyssynchrony, which may cause respiratory alkalosis, lung distension, and complicate the process of weaning from mechanical ventilation. <br /><br />Such auto-triggering can occur due to various reasons such as circuit leaks or cardiogenic oscillations, and it was observed in this patient due to an increase in abdominal pressure transmitting to the thoracic cavity. The condition is often underrecognized in intensive care units (ICUs), but it can lead to prolonged mechanical ventilation and increased mortality. The report emphasizes the importance of identifying and addressing the underlying physiological conditions that exacerbate auto-triggering, using methods like changing ventilator settings or resolving conditions causing increased thoracic pressures. <br /><br />The document discusses how cardiogenic oscillations, described as early as 1942, affect ventilator function. They are thought to contribute to pulmonary airflow due to changes in intracardiac volume and pressure changes in the thoracic cavity. Addressing these issues is important for ensuring proper ventilator function and patient outcomes in critical care settings.
Keywords
hemorrhagic shock
hemoperitoneum
paracentesis
mechanical ventilation
cardiogenic auto-triggering
patient-ventilator dyssynchrony
respiratory alkalosis
cardiogenic oscillations
intensive care units
thoracic pressure
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