Delayed tracheal extubation after cardiac surgery due to cardiogenic ventilator auto-triggering: a case report

Takekawa, Daiki; Uchida, Satoshi; Hirota, Kazuyoshi

BACKGROUND: Ventilator auto-triggering is associated with poor outcomes. Herein, we present a case of delayed tracheal extubation after cardiac surgery due to cardiogenic auto-triggering. CASE PRESENTATION: A 73-year-old male with chronic constrictive pericarditis underwent radical pericardiectomy. After confirming hemodynamic stability, we conducted spontaneous breathing trial (SBT) with a flow-trigger sensitivity of 1 L/min. As his respiratory rate (RR) increased to more than 60 breaths/min and tidal volume decreased to less than 100 mL, this SBT was considered a failure. Next morning, SBT was reperformed and the result was unchanged. However, we noticed that his heart rate and RR were the same and suspected auto-triggering caused by cardiogenic oscillations. We changed ventilator mode from flow triggering to pressure triggering of −2 cmH(2)O and he was uneventfully extubated. CONCLUSION: We experienced a case of delayed tracheal extubation after cardiac surgery due to cardiogenic auto-triggering. Auto-triggering can be reduced by changing ventilator trigger mode.