case_images: PMC9357904_01
case_images: (A) shows a 5 min ventilator download traces in Breas PC software (Breas Medical, Molnlycke, Sweden). The leaks were in its majority in the intentional range for the type of interface. The arrows indicate the decrease in flow. To note an overshoot of the pressure during the patient's triggered cycles (circle). (B) shows an 5 min epoc downloaded to Breas PC software (Breas Medical, Molnlycke, Sweden) with the addition of SpO2 monitoring and thoracic [THOR (pink)] and abdominal [AB (black)] belts connected to the ventilator. The bold thick arrow shows an important desaturation and the thin arrow shows an obstructive event with persistent ventilatory drive. (C) shows the thoracoabdominal trace in 1 min epoc: in the upper image we can see opposition of phases, marked with a circle, with the abdominal band (black) slightly weaker, and we can compare it to the lower image were we can see normal thoracoabdominal movements. (D) shows a 5 min epoc in Breas  PC software (Breas Medical, Molnlycke, Sweden). Note, we no longer observe obstructive events.
case_images: fmed-09-852896-g0001.jpg
case_images: PMC9357904_01_fmed-09-852896-g0001.jpg
case_images: F1
case_images: An example of the ventilator download can be seen in Figure 1A. The ventilator flow traces with the additional monitoring were downloaded and showed a persistent ventilatory drive, as we can identify the thoracoabdominal movements; phase opposition of the abdominal and thoracic belts (Figure 1C, upper image); slight decrease in abdominal activity at the same time as the decrease in flow (Figure 1B); decrease in oxygen saturation. We therefore increased the EPAP by 1 cmH2O, keeping the same Pressure Support (PS) and subsequent evaluation of the traces revealed a decrease in obstructive events (Figure 1D).
case_images: PMC9357904_02
case_images: (A) shows a 5 min epoc in Breas  PC software (Breas Medical, Molnlycke, Sweden). The arrows highlights obstructive events. (B) shows a 5 min epoc in Breas  PC software with the addition of SpO2 probe and abdominal [AB (black)] and thoracic [THOR (pink)] belts. The bold arrow shows important desaturation and the thin arrow shows the absence of movement of belts.
case_images: fmed-09-852896-g0002.jpg
case_images: PMC9357904_02_fmed-09-852896-g0002.jpg
case_images: F2
case_images: Downloaded overnight ventilator traces showed an absence of leaks and a decrease in flow (Figure 2A). In these traces, we noticed an absence of movement of the thoracoabdominal belts, followed by desaturation (Figure 2B).
case_images: PMC9357904_03
case_images: (A), Shows a 1 min epoc of the traces of a Lumis 150 ventilator (Resmed, San Diego, CA, USA) using Rescan program (ResMed, Lyon, France). The leak is close to 0l/mn. The arrow indicates the asynchrony. (B) Shows a 1 min epoc of the traces on a Breas   PC software showing the abdominal [AB (black)] belt and thoracic belt [THOR (pink)], the dotted vertical line shows a late cycling. (C) shows a 1 min epoc of the traces of a Resmed   ventilator using Rescan software.
case_images: fmed-09-852896-g0003.jpg
case_images: PMC9357904_03_fmed-09-852896-g0003.jpg
case_images: F3
case_images: When the ventilator traces were downloaded and reviewed using the Rescan  (Resmed, San Diego, CA, USA), an intracycle asynchrony was noted (Figure 3A), This made us want to establish its nature. We clearly identified a late cycling of the device because, the thoracoabdominal movements change to expiration before the ventilator finishes delivering the breath in (Figure 3B). Ti minimum. The following morning we downloaded the ventilator traces, we found the late cycling had been resolved (Figure 3C).
case_images: (A) shows a 1 min reading of the traces of a Lumis 150 ventilator (Resmed, San Diego, CA, USA) using Rescan program (Resmed, San Diego, CA, USA). The arrows indicate patient ventilator asynchrony. (B) shows a 1 min epoc in Breas  PC software (Breas Medical, Molnlycke, Sweden). Two intracycle effort with deformation of the pressure curve are shown with a hollow arrow and two doble triggering are shown between two dotted vertical lines. These, are signs of "air hunger." (C) shows a 1 min epoc of the traces of the Lumis 150 ventilator using the Rescan program.
case_images: fmed-09-852896-g0004.jpg
case_images: PMC9357904_03_fmed-09-852896-g0004.jpg
case_images: F4
case_images: However, we noted, different PVAs (Figure 4A) that we could interpret as either late cyclings or intracycle efforts. All these PVA suggest "air hunger" (Figure 4B). Thus, we increased his IPAP by 2 cmH2O which led to the asynchronism to disappear (Figure 4C).