Ventilator Graphics v3.

Charles Williams
RRT, AE-C
 Learner Objectives

Understand the importance of monitoring and

interpreting ventilator graphics.
Learn the basic shapes of waveforms.
Identify the different types of waveforms and
loops available on most ventilators.
Learn to use the graphics to identify
patient/ventilator problems, and make the
appropriate adjustments.
Why do we monitor ventilator graphics and
waveforms?

Allows practitioners to evaluate and

troubleshoot the patients response to the
ventilator.
Monitor proper ventilator function.
Monitor the patients disease status
(Compliance and Airway Resistance).
Assess response to therapy.
Allow fine tuning of ventilator to decrease
WOB, optimize ventilation, and maximize
patient comfort.
Ventilator graphics are waveforms that
reflect the patient-ventilator system
and their interaction.
 Learning to analyze and interpret
ventilator graphics can be a very useful
tool for respiratory therapists.

The graphics can assist therapists in

making recommendations and necessary
adjustments to the ventilator.
 Practitioners can use ventilator graphics to
assess the condition of a patients lungs in
the same way a cardiologist uses the graphics
of an EKG to view the condition of the heart.
 Puritan Bennett 840
Hamilton Galileo

Drager Evita

Respironics Esprit

The graphics display will have different appearances and

configurations, depending on the make and model of ventilator.
Basic Shapes of Waveforms

Basic waveforms that

Scalars plot pressure, flow, or
volume against time.
Time
Time is on the x-axis.

Waveforms that
combine pressure or
Loops flow, with volume.
(P/V or F/V). There is
no time component.
Basic Shapes of Waveforms

Generally, The ascending and descending ramps can

be considered the same as exponential ramps, So
you really only need to remember three shapes:
Square, Ramp, and Sine waves.
Basic Shapes of Waveforms

Squares represent fixed,

Squares constant, or set parameters. For
example, pressure setting in
Pressure Control mode.

Ramps represent variables.

Ramps Will vary with changes in lung
characteristics.
Ramps can be accelerating or
decelerating.

Sine waves are seen with

Sine spontaneous, unassisted
breathing.
Basic Shapes of Waveforms

Question:
What are the three basic shapes of
waveforms?
Answer:
Square
Ramp
Sine
 Types of Waveforms

3
Each time the ventilator delivers a breath, there are
waveforms that are displayed on the graphics screen: Pressure,
Flow, and Volume.
 Types of Waveforms

(20)

The pressure scalar displays the amount of pressure generated

with each breath. The scale is located on the left side in cmH20.
The peak pressure of these breaths are about 22 cmH20.
 Types of Waveforms

The flow scalar displays the flowrate, or speed associated with

each breath.
In this example, the breath begins at a fast flowrate and then
decreases during inspiration.
 Types of Waveforms

(375 ml)

(250 ml) Volume out

Volume in

The volume scalar displays the amount of volume inhaled and

exhaled with each breath. The scale is located on the left side in
mls.
These breaths are about 370 ml.
 Types of Waveforms

Question:
What 3 waveforms are displayed on the
graphics screen?
Answer:
Pressure
Flow
Volume
 Types of Waveforms Pressure Modes
Volume Modes

Pressure Pressure
square

Flow Flow
square

Volume Volume

Pressure Control
Volume Control Pressure Support
*PRVC
SIMV (Vol. Control) *Volume Support
SIMV (PRVC)
SIMV (Press. Control)
* Considered a dual-mode of ventilation
 Types of Waveforms

Volume Modes Pressure Modes

Pressure Pressure

Flow Flow

Note: Some ventilators allow you select the desired flow pattern for different modes.
 Types of Waveforms
SIMV (Vol. Control)
+ Pressure Support

Volume Volume
Breath Pressure Pressure Breath
Breath Breath

For combination modes, such as SIMV/PS, the graphics can show both
volume breaths and pressure breaths.
 Pressure Waveform
Volume Modes Pressure Modes

Pressure Pressure
square

Flow Flow
square

Volume Volume

Pressure Control
Volume Control Pressure Support
PRVC
SIMV (Vol. Control) Volume Support
SIMV (PRVC)
SIMV (Press. Control)
 Pressure Waveform

The pressure waveform can be used to assess:

Breath Type (Pressure vs. Volume)
Air trapping (auto-PEEP)
Airway Obstruction
Bronchodilator Response
Respiratory Mechanics (Compliance/Raw)
Active Exhalation
PIP, Pplat
CPAP, PEEP
Asynchrony
Triggering Effort
 Pressure Waveform

Volume Modes Pressure Modes

If the ventilator delivers a If the ventilator delivers a

volume breath, the shape pressure breath, the shape
of the pressure waveform of the pressure waveform
will be a ramp.
will have a square shape.

square

Ramp = variable Square = constant

 Pressure Waveform

Volume Modes Pressure Modes

This means that pressure will This means that pressure

vary, depending on lung will remain the same
characteristics; (compliance,
airway resistance, etc.) during inspiration.

Ramp = variable Square = constant

 Pressure Waveform

Pressure waveform Pressure waveform with

inspiratory pause
PIP
Raw
Pplat

Setting an inspiratory pause time or performing an insp. hold

maneuver, will create a plateau on the waveform.
The plateau allows for easy visualization of PIP, Pplat, and Raw.

Adding an inspiratory pause time may improve distribution of

ventilation.
Pressure Waveform

I-time
Peak Inspiratory Pressure
(PIP)

Plateau Pressure (Pplat)

Alveolar Elastic
Distending Recoil
Pressure Pressure

= Mean Airway Pressure (MAP)

 Pressure Waveform

10

5
PEEP PEEP PEEP
No Patient
patient effort triggered breath

The baseline for the pressure waveform will be higher, when Positive End-
Expiratory Pressure (PEEP), is added. PEEP is also a component of mean airway
pressure (MAP).

With patient triggered breaths, there will be a negative deflection just before
the waveform.
Pressure Waveform

Peak Inspiratory Pressure

I-time (PIP)
 Pressure Waveform

Increased Airway Resistance (Raw) Decreased Compliance

PIP PIP
(Normal Raw)
(Increased Raw) Pplat
Pplat

Increased airway resistance (Raw) will cause the PIP to increase. The Pplat pressure
remains normal.

Decreased lung compliance will cause the entire waveform to increase in size. The
difference between PIP and Pplat will remain normal.
 Pressure Waveform

Air-Trapping (auto-PEEP)

Expiratory hold
maneuver

auto-PEEP (trapped air)

auto-PEEP
+9
PEEP PEEP
Set PEEP +5

Total-PEEP +14
While performing an expiratory hold maneuver, trapped air will cause the waveform to
rise above the baseline.

An acceptable amount of auto-PEEP should be < 5cm H2O.

 Pressure Waveform

Label the parts:

A
B

C
=G

E
F

A= Inspiratory Time D= Airway Resistance (Raw) G= Mean Airway Pressure (MAP)

B= Peak Insp. Pressure (PIP) E= Alveolar Distending Pressure
C= Plateau Pressure (Pplat) F= Elastic Recoil Pressure
Pressure Waveform

Question:
What does this pressure waveform show?

Answer: Increased airway resistance

 Flow Waveform
Volume Modes Pressure Modes

Pressure Pressure
square

Flow Flow
square

Volume Volume

Pressure Control
Volume Control Pressure Support
PRVC
SIMV (Vol. Control) Volume Support
SIMV (PRVC)
SIMV (Press. Control)
 Flow Waveform

If a volume breath is If a pressure breath is

delivered, the shape of the delivered, the shape of the
waveform will be a square. waveform will be a ramp.
This means that the This means that the
flowrate stays the same flowrate starts out high
during inspiration. and then decreases during
inspiration.

Square = constant Ramp = variable

 Flow Waveform

The flow waveform can be used to assess:

Air trapping (auto-PEEP)
Airway Obstruction
I-Time adjustment
Bronchodilator Response
Active Exhalation
Breath Type (Pressure vs. Volume)
Inspiratory Flow
Asynchrony
Triggering Effort
 Flow Waveform

Volume Modes Pressure Modes

I-time I-time

Set Flowrate PIF

E-time E-time

PEF PEF
 Flow Waveform

The decelerating flow pattern may be preferred over the constant flow pattern.
The same tidal volume can be delivered, but with a lower peak pressure.
 Flow Waveform

Airway Obstruction
Inspiratory flow takes longer to return
PIF
to baseline

= Normal
PEF

In patients with severe airway obstruction, the flow waveform can become a
plateau.
This can become a problem in flow-cycled modes, such as Pressure Support.
(asynchrony, W.O.B.)
 Flow Waveform
Auto-Peep (air trapping)

Expiratory flow does not

return to baseline

Start of
next breath
= Normal

If the expiratory portion of the waveform doesnt return to baseline before the
start of the next breath starts, there could be air trapping. (emphysema,
improperly set I:E ratio).
 Flow Waveform

Bronchodilator Response
Pre-Bronchodilator Post-Bronchodilator

I-time

Prolonged E-time Normal E-time

Reduced PEF
Improved PEF
To assess response to bronchodilator therapy, you should see an increase in
peak expiratory flow rate.

Also, the expiratory portion of the curve should return to baseline sooner.
 Flow Waveform
Pressure Control, Pressure Support,
PRVC Adjusting Volume Support
(Time-cycled) (Flow-cycled)
I-Time

Pressure

Inspiration should Inspiration ends

end when flow before flow
Flow reaches baseline reaches baseline

Volume

In Pressure modes that are time-cycled (Pressure Control), the flow waveform should return to
baseline.
In Pressure modes that are flow-cycled (Pressure Support), the flow waveform does not return to
baseline. (Adjustment is made with Insp. Cycle Off %)
 Flow Waveform
Adjusting I-Time

I-time I-time
(Too short) (Too long)

Not here Inspiration should end

here

Inspiration should end Not here

here

Remember, this applies to Control modes with a decelerating flow (ramp).

This includes Pressure Control, PRVC, SIMV (Press. Control), and SIMV (PRVC).

Volume Control and SIMV (Vol. Control) have a constant flow.

 Flow Waveform
Question:
What does this flow pattern show?

Answer:
Air trapping (auto-PEEP)
 Flow Waveform
Question:
To assess improvement after a breathing treatment you should
see what?
Pre-Bronchodilator Post-Bronchodilator
I-time

Normal E-time

Improved PEF

Answer:
Improved PEF and shorter E-time
 Volume Waveform
Volume Modes Pressure Modes

Pressure Pressure
square

Flow Flow
square

Volume Volume

Pressure Control
Volume Control Pressure Support
PRVC
SIMV (Vol. Control) Volume Support
SIMV (PRVC)
SIMV (Press. Control)
 Volume Waveform

Volume Modes Pressure Modes

The Volume waveform will There may also be a

generally have a small plateau at the top
mountain peak shape of the volume waveform
regardless of what mode,
of ventilation.
 Volume Waveform

The volume waveform can be used to assess:

Tidal Volume
Active Exhalation
Asynchrony
Airway Resistance
Air trapping (auto-PEEP)
Leaks
Volume Waveform

Inspiratory
Tidal Volume

Exhaled volume should return

to baseline
 Volume Waveform
Air-Trapping or Leak

Volume Loss

If the exhalation side of the waveform doesnt return to baseline,

it could be from air-trapping (improperly set I-time, emphysema),
or there could be a leak (ET tube, vent circuit, chest tube, etc.)
 Volume Waveform

Increased Airway Resistance

= Normal

Exhaled volume
taking longer to get out

If there is an increase in airway resistance, it will take longer for

the exhaled volume to return to baseline.
This is more commonly seen with a damp or blocked expiratory
filter/valve.
 Volume Waveform

Question:
The volume waveform is most commonly used to assess which
two situations?

Answer:
Air trapping and leaks
 Is it Volume or Pressure?
Volume Modes Pressure Modes

Pressure Pressure
square

Flow square Flow

Volume Volume

Here is an easy way to tell what type of mode (or type of breath) this is, just by looking at the
graphics.
Look at the pressure waveform and remember the letter P.
With Pressure breathsThe Pressure waveformwill have a Plateau.
 Is it Volume or Pressure?

The pressure waveform has a plateau

The flow waveform doesn't return to baseline

Is it a Volume or Pressure mode? (Hint: look at the pressure waveform)

Is it a Control mode or Support mode? (Hint: look at the flow waveform)
Volume Modes
Pressure Modes
 Ventilator Graphics

Pressure-
Volume
Loops
 Pressure-Volume Loops

Volume is plotted on the y-axis, Pressure on the x-axis.

Inspiratory curve is upward, Expiratory curve is downward.
Spontaneous breaths go clockwise and positive pressure
breaths go counterclockwise.
The bottom of the loop will be at the set PEEP level. It will be
at 0 if theres no PEEP set.
If an imaginary line is drawn down the middle of the loop,
the area to the right represents inspiratory resistance and the
area to the left represents expiratory resistance.
 Pressure-Volume Loops

The Pressure/Volume Loop can be used to assess:

Lung Overdistention
Airway Obstruction
Bronchodilator Response
Respiratory Mechanics (C/Raw)
Flow Starvation
Leaks
WOB
Triggering Effort
 Pressure-Volume Loops

Volume Modes Pressure Modes

In Volume modes, the P/V loop In Pressure modes, the P/V

will normally have a football loop will have a square
shape. appearance.
 Pressure-Volume Loops

Dynamic
Compliance
500
(Cdyn)

250

5 10 15 20

If PEEP is added, the loop will begin at the set PEEP level.
The top part of the P/V loop represents Dynamic compliance (Cdyn).
Cdyn = volume/pressure
 Pressure-Volume Loops

500
Plateau

250

10 20

Pressure modes deliver a set constant pressure during inspiration, creating a

plateau on the pressure waveform. This will also create a plateau on the P/V
loop.
 Pressure-Volume Loops
Overdistention
beaking
500

250

10 20

Pressure continues to increase with little or no change in volume,

creating a bird beak. Fix by reducing amount of tidal volume
delivered.
 Pressure-Volume Loops
Triggering Effort

WOB

tail

If the patient is triggering the breath, you will see a crossover or tail, at the beginning
of the loop.
As WOB increases, the tail will become larger.
 Pressure-Volume Loops
Airway Resistance

500
Increased
expiratory
resistance:
secretions,
bronchospasm, 250
etc.
Increased
inspiratory
resistance:
ETT size too small,
10 20 tube kinked,
patient biting tube,
etc.

As airway resistance increases, the loop will become wider. An increase in

expiratory resistance is more commonly seen.
 Pressure-Volume Loops

Increased Compliance Decreased Compliance

Cdyn
500 500

Cdyn
250 250

10 20 10 20

Examples: Cdyn = Dynamic Compliance Examples:

(volume/pressure)
Emphysema, ARDS, CHF,
Post Surfactant Therapy Atelectasis, Pleural Effusions
 Pressure-Volume Loops

Increased Compliance Decreased Compliance

600/12
600 Cdyn = 50 ml/cmH20

500 500

Increased 300/22
volume 300 Cdyn = 14 ml/cmH20

250 250

Decreased
volume
12
22

Decreased Increased
pressure
10 20 10 pressure 20

Examples: VT (Tubing compliance) Examples:

Cdyn =
Emphysema, PIP - PEEP ARDS, CHF,
Post Surfactant Therapy Atelectasis, Pleural Effusions
 Pressure-Volume Loops
A Leak
500

250

10 20

The expiratory portion of the loop does not return back to baseline. This
indicates that there is a leak.
 Pressure-Volume Loops
Upper
point of
alveolar collapse Inflection
Point
500 Third Inflection Point

250

Lower
Inflection point of
Point alveolar opening

10 20

Inflection Points
Some lung protection strategies for treating ARDS, suggest setting PEEP just above the
lower inflection point, to hold the alveoli open.
 Pressure-Volume Loops

500

250

10 20

Question: What does this loop show?

Answer: Decreased lung compliance. (ARDS, CHF, Atelectasis)

 Pressure-Volume Loops

500

250

5 15 30

Question: What is happening when there is a bird beak appearance on the P/V
loop?
Answer: Lung overdistention. Pressure continues to increase, with no
increase in volume.
 Pressure-Volume Loops

Question: What does this P/V loop show?

Answer: Increased expiratory airway resistance (Raw).

 Ventilator Graphics
40

20
200 600
0

20

40
Flow-
Volume
Loops
 Flow- Volume Loops

Flow is plotted on the y axis and volume on the x axis

Flow volume loops used for ventilator graphics are the same
as ones used for Pulmonary Function Testing, (usually upside
down).
Inspiration is above the horizontal line and expiration is below.
The shape of the inspiratory portion of the curve will match
the flow waveform.
The shape of the exp flow curve represents passive
exhalation.
Can be used to determine the PIF, PEF, and Vt
Looks circular with spontaneous breaths
 Flow-Volume Loops

The Flow/Volume Loop can be used to assess:

Air trapping
Airway Obstruction
Airway Resistance
Bronchodilator Response
Insp/Exp Flow
Leaks
Water or Secretion accumulation
Flow Starvation
Asynchrony
Flow-Volume Loops
60

40

20

Begin Begin
Inspiration Expiration
0
200 400 600

-20

-40

Peak
Expiratory
-60
Flow (PEF)
 Flow-Volume Loops

Constant Flow Variable Flow

0 0

The shape of the inspiratory portion of the curve will match the flow
waveform.
 Flow-Volume Loops

Airway Obstruction
PEF

Reduced PEF

scooping

0 PFT 0
view

With conditions that cause airway obstruction (asthma), you will see a lower peak
expiratory flow (PEF).
You should also see scooping on the expiratory portion of the loop. *Scooping means
that the volume is being exhaled at a slower rate because of obstruction.
 Flow-Volume Loops

Airway Obstruction

Ventilator
0 0
graphic
view
scooping

Reduced Peak Flow (PEF)

The F-V loop appears upside down on most ventilators.

 Flow-Volume Loops
60

Air Trapping or Leaks

40

20

0
200 400 600

-20
loss of
volume
-40

= Normal
-60

If there is air-trapping, or a leak, the loop will not meet at the starting point
where inhalation starts and exhalation ends.
 Flow-Volume Loops
Water or Secretions

If there is a collection of water in the ventilator circuit or a build up of

secretions, you will see a jagged, sawtoothed pattern.
 Flow-Volume Loops

20

Begin Begin
Inspiration Expiration
0
200 400 600

Peak
Expiratory
-60
Flow (PEF)

What points on this F/V loop do the arrows indicate?

 Flow-Volume Loops
60

40

20

0
200 400 600

-20

-40

-60

Question: What does this F/V loop show?

Answer: There is air-trapping or a leak. (ETT cuff, vent circuit)
 Flow-Volume Loops

0 0

Question: What is the term used to describe the part of the loop
indicated by the arrow? What causes it?

Answer: This is known as scooping. Its caused by small airway obstruction.

 Asynchrony
(out of sync)

Flow Starvation

The inspiratory portion of the pressure waveform shows a dip.

Because of an inadequate flowrate , the patient is sucking in attempting to
get more air. This causes a drop in pressure.
A main disadvantage of constant flow modes (e.g. Volume Control), is that it
may not meet the patients inspiratory demands.
 Asynchrony
(out of sync)

Dip
Flow Starvation

Ventilator detects inadequate flow

Some ventilators have an adaptive flow system that will automatically

increase flow to try and meet the patients demand.
Notice that on the next breath, the flowrate has been increased.
 Asynchrony
(out of sync)

F/V Loop P/V Loop

Any dips or irregular shaped loops are an indication of asynchrony.

 Air-Trapping (auto-PEEP)
Causes:
Insufficient expiratory time
Early collapse of unstable alveoli/airways during exhalation
How to Identify it on the graphics:
Pressure waveform: While performing an expiratory hold, the
waveform rises above baseline.
Flow waveform: The expiratory flow wave doesnt return to baseline
before the next breath begins.
Volume waveform: The expiratory portion doesnt return to baseline.
Flow/Volume Loop: The loop doesnt return completely to baseline
Pressure/Volume Loop: The loop doesnt return completely to
baseline
How to Fix:
Give a bronchodilator treatment, adjust I-time, increase flow, adjust
PEEP.
 Airway Resistance Changes
Causes:
Bronchospasm
ETT problems (too small, kinked, obstructed)
High flow rate
Secretion build-up
Damp or blocked expiratory valve/filter
Water in the HME
How to identify it on the graphics:
Pressure waveform: PIP increases, but the plateau stays the same
Flow waveform: It takes longer for the exp side to reach baseline
Volume waveform: It takes longer for the exp curve to reach the baseline
Pressure/Volume loop: The loop will be wider. Increased insp.
resistance will cause it to bulge to the right. Increased exp resistance will
cause it to bulge to the left.
Flow/Volume loop: decreased exp flow, scooping on the exp curve
How to fix:
Give a bronchodilator treatment, suction patient, drain water, change
HME, change ETT, add a bite block, reduce flowrate, change exp filter.
 Compliance Changes
Decreased compliance Increased compliance
Causes Causes
ARDS Emphysema
Atelectasis Surfactant Therapy
Abdominal distension
CHF
Consolidation
Fibrosis
Overdistention
Pneumothorax
Pleural effusion How to identify it on the
How to identify it on the graphics:
graphics: Pressure wave: PIP and
Pressure wave: PIP and plateau both decrease
plateau both increase Pressure/Volume loop:
Pressure/Volume loop: Stands more vertical
lays more horizontal (upright)
 Leaks
Causes:
Expiratory leak: ETT cuff leak , chest tube leak, BP fistula, NG
tube in trachea
Inspiratory leak: Loose connections, ventilator malfunction,
faulty flow sensor
How to identify it on the graphics:
Volume waveform: Expiratory side of wave doesnt return to
baseline
Flow waveform: PEF decreased
Pressure/Volume loop: Exp side doesnt return to the baseline
Flow/Volume loop: Exp side doesnt return to baseline
How to fix it:
Check possible causes listed above
Do a leak test and make sure all connections are tight
 Asynchrony
Causes: (Flow, Rate, or Triggering)
Air hunger (flow starvation)
Neurological Injury
Improperly set sensitivity
How to identify it on the graphics:
Pressure waveform: Patient tries to inhale/exhale in the middle of the
waveform, causing a dip in the pressure
Flow waveform: Patient tries to inhale/exhale in the middle of the waveform,
causing erratic flows/dips in the waveform
Pressure/Volume loop: Patient makes effort to breath causing dips on either
inspiratory or expiratory side.
Flow/Volume loop: Patient makes effort to breath causing dips in loop on either
inspiratory or expiratory side.
How to fix it:
Try increasing the flow rate, decreasing the I-time, or increasing the set rate to
capture the patient to better meet the patients needs.
Change the mode - sometimes changing from partial to full support will solve the
problem.
If neurological, may need paralytic or sedative.
Adjust sensitivity
 The pressure waveform does have a plateau, but its
from an insp. hold or set insp. pause.

square

Is this a Volume or Pressure mode?

 Ventilator Graphics

Adjusting
Rise time
&
Insp.
Cycle Off
%
 Rise Time

Rise Time

The inspiratory rise time is the time it takes to reach full

inspiratory flow, or pressure, at the start of each breath.

The rise time can be expressed as a percentage of the breath

cycle time (%) or in seconds (s).
 Rise Time

The Bart Simpson spike

Rise time overshoots

desired pressure

Too fast

If rise time is set too fast, you can get an overshoot in the pressure wave,
creating a pressure spike.
If this occurs, you need to increase the rise time. This makes the flow valve
open more slowly.
 Rise Time

1. Here we can see the spike on our 2. The rise time is set at .05 seconds
graphics.
 Rise Time

3. When we increase the rise time, thus 4. the waveform will return to
making it slower normal.
 Rise Time

Too slow

If rise time is too slow, the pressure waveform will become more slanted,
when it should look more square. This may affect Vt delivery and may not
meet the patients inspiratory demands.
If this occurs, you will need to decrease the rise time to open the valve faster.
 Inspiratory Cycle off %
(Flow Cycling)

In flow-cycled modes, like Pressure Support & Volume

Support, the inspiratory cycle off % determines when
the ventilator cycles from inspiration to expiration.

Also know as:

Inspiratory cycle threshold
Inspiratory flow termination,
Expiratory flow sensitivity,
Inspiratory flow cycle %,
E-cycle, etc
 Inspiratory Cycle off %
(Flow Cycling)

pressure

Inspiration ends

flow

The inspiration ends when inspiratory flow has dropped to a specific flow value.
 Inspiratory Cycle off %
(Flow Cycling)

Peak Inspiratory Flow

(PIF)
100%

75%

50%
Flow 30%
25%

In the above example, the ventilator is set to stop inspiration and begin
expiration, at 30% of the patients peak inspiratory flow (PIF).
 Inspiratory Cycle off %
(Flow Cycling)

The ventilator will cycle off inspiration at

this point

and then begin expiration

 Inspiratory Cycle off %
(Flow Cycling)

Exhalation
spike

100% 100%

60%
10%

The cycle off percentage is too high The cycle off percentage is too low (10%),
(60%), cycling inspiration off too soon. This makes the breath too long.

This makes the breath too small. (not This forces the patient to actively exhale
enough Vt.) against the breath, creating a pressure
spike. (increases WOB),
 Rise Time

Question:
What does this waveform show?

Answer: Rise time is too slow

 Inspiratory Cycle off %
(Flow Cycling)

Question:
This pressure support breath is set to insp. cycle off
at 80%, 50%, 30%, or 10%?
100%

75%
Flow

50%

25%

Answer: 30%
 Sources:

Rapid Interpretation of Ventilator Waveforms,

Waugh, Harwood, and Deshpande

Ventilator Waveform Analysis, Pearson

Anatomy of Servo-i Graphics, Maquet, inc.

Golden Moments in Mechanical Ventilation,
Maquet, inc.
Ventilator Graphics

Me using the flow

waveform
to adjust I-time

Thank You!