Flow Trigger Adjustment for Ventilator Weaning

Understanding Flow Triggers and Weaning

In patients with intrinsic PEEP, even a sensitive flow trigger may not be sufficient to overcome the inspiratory threshold load, and application of external PEEP may be necessary to counterbalance intrinsic PEEP and improve triggering in patients with conditions like COPD 1
The American Thoracic Society recommends considering using flow triggering in conjunction with non-invasive ventilation for patients with hypercapnic respiratory failure to facilitate weaning from mechanical ventilation 3, 4

For COVID-19 patients with tracheostomy, the American Academy of Otolaryngology-Head and Neck Surgery recommends pressure support mode with an inflated cuff over spontaneous breathing trials using T-piece during weaning to minimize aerosol generation 2
The European Respiratory Society suggests that when transitioning from mechanical ventilation, an HME with viral filter should be placed to decrease expulsion of viral particles, although this is based on a recommendation for COVID-19 patients 2

The American College of Chest Physicians recommends that for patients with high levels of intrinsic PEEP, external PEEP (typically up to 85% of measured intrinsic PEEP) should be applied to improve triggering sensitivity 1