Two Breaths, One Effort: Understanding Double Triggering

Double triggering occurs when a patient-initiated breath continues with neural inspiration beyond the end of mechanical inflation, causing another breath to be triggered. This phenomenon, known as early cycling, happens when the mechanical inflation time is shorter than the patient's neural inspiratory time. 

In this case, the Expiratory Trigger Sensitivity (ETS), also referred to as the end-inspiration setting or flow termination criterion, was initially set at 25%. 

To address early cycling in pressure support mode, the ETS should be reduced to a lower percentage to prolong the mechanical inflation time, aligning it with the neural inspiratory time. Adjusting the ETS from 25% to 15% successfully resolved the double-triggering issue.