Multiple Dyssynchronies in a Single Waveform

Work shifting: During the initial phase of inspiration, the pressure is lower than the set Positive End-Expiratory Pressure (PEEP) because of the large inspiratory efforts (strong Pmus).

Late cycling (delayed cycling): As the inspiratory muscles relax and expiratory muscles contract, the pressure waveform rises above the baseline.

The patient completes a breath (inspiration and expiration) and begins another breath within the set inspiratory time. This can be identified by the pressure drop during the plateau phase (failed/ineffective trigger). This situation arises when the spontaneous RR is much higher than the set RR or the set inspiratory time is much longer than the neural inspiratory time. The loss of normal exponential decay pattern of expiratory flow-time scalar is suggestive of expiratory work.