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Time (sec)

Ventilator screen display. Flow (l/sec). Paw (cmH 2 O). 5 sec. Time (sec). Ventilator f r equency = 12 b reaths /min. From Georgopoulos D et al Intensive Care Med. 2006;32:34-47 , figure 2. Flow (l/sec). Paw (cmH 2 O). Pes (cmH 2 O). 5 sec. Time (sec).

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  1. Ventilator screen display Flow (l/sec) Paw (cmH2O) 5 sec Time (sec) Ventilator frequency = 12 breaths/min From Georgopoulos D et al Intensive Care Med. 2006;32:34-47, figure 2

  2. Flow (l/sec) Paw (cmH2O) Pes (cmH2O) 5 sec Time (sec) Patient’s frequency = 35 breaths/min From Georgopoulos D et al Intensive Care Med. 2006;32:34-47, figure 2

  3. Normal breath from the relaxation volume of the respiratory system with expiratory muscle use Relaxation Volume inspiratory muscle relaxation Beginning of expiratory effort End ofinspiration Pinsp Pexp

  4. Normal breath overcoming ventilator trigger from the relaxation volume of the respiratory system with expiratory muscle use Relaxation Volume Ptr

  5. PEEPi Ptr Relaxation Volume Breath from increased end-expiratory lung volume due to the presence of dynamic hyperinflation in COPD Wasted effort Dynamic Hyperinflation

  6. wasted expiratory effort Relaxation Volume Wasted efforts are due to breath by breath increases in end-expiratory lung volume due to overassistance, delayed lung emptying and short expiratory time Ptr

  7. Relaxation Volume PEEPexternal Addition of external PEEP can attenuate wasted efforts Ptr

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