Early Cycling or Late Cycling?

The expiratory flow–time scalar shows a small upward deflection early in expiration, which could be mistaken for early cycling dyssynchrony. However, a closer look at the inspiratory flow–time scalar reveals two distinct flow peaks. The first peak corresponds to the initial inspiratory effort, while the second peak represents a new inspiratory effort that begins just before the ventilator cycles to expiration and continues into the expiratory phase, creating waveform changes that resemble early cycling.

In this situation, the pattern is better identified as late cycling, as there is a delay in transitioning to expiration, causing the patient to complete one breath and initiate another within the same inspiratory phase.