Chest
Volume 100, Issue 4, October 1991, Pages 1172-1173
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Ventilator Autocycling due to an Endotracheal Tube Cuff Leak

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Ventilator autocycling can occur with any ventilator if the sensitivity is improperly set or if a gas leak exists in the respiratory system which creates a negative change in proximal airway pressure. We report a case of ventilator autocycling in a paralyzed patient secondary to an endotracheal cuff leak which was misconstrued as assisted ventilation. We believe this is the first report of autocycling due to a cuff leak.

Section snippets

CASE REPORT

A 21-year-old woman was admitted to the hospital complaining of fever, nonproductive cough and dyspnea over three days. She had been diagnosed with stage IIb Hodgkin's disease one year earlier and had completed eight cycles of chemotherapy (BCNU, cytoxan, vinblastine, procarbazine and prednisone) and received 3,000 rads of mental and mediastinal radiation prior to admission. On admission, she was treated with broad-spectrum antibiotics, including trimethaprim-sulfamethoxazole, for a left lower

DISCUSSION

This is the first report, to our knowledge, of ventilator autocycling secondary to an endotracheal tube cuff leak. The ventilator autocycled because it correctly sensed a drop in proximal airway pressure, and when the inspiratory threshold pressure was lowered to a point below the end-expiratory pressure of the proximal airway, the autocycling stopped. Thus, in this type of ventilator autocycling, the ventilator was sensing and responding properly to a drop in pressure caused by the gas leak

ACKNOWLEDGMENTS:

The authors are grateful to Mr. Daniel C. Barrett for preparation of the manuscript.

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Supported by a national American Lung Association grant.

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