• Annemijn H Jonkman, Minke C Holleboom, Heder J de Vries, Marijn Vriends, Pieter R Tuinman, and HeunksLeo M ALMADepartment of Intensive Care Medicine, Amsterdam University Medical Center, location VUmc, Amsterdam, The Netherlands; Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, The Netherlands. Electronic address: l.heunks@.
• Department of Intensive Care Medicine, Amsterdam University Medical Center, location VUmc, Amsterdam, The Netherlands; Department of Intensive Care Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
• Chest. 2022 Jun 1; 161 (6): e337e341e337-e341.

AbstractIn critically ill patients receiving mechanical ventilation, expiratory muscles are recruited with high respiratory loading and/or low inspiratory muscle capacity. In this case report, we describe a previously unrecognized patient-ventilator dyssynchrony characterized by ventilator triggering by expiratory muscle relaxation, an observation that we termed expiratory muscle relaxation-induced ventilator triggering (ERIT). ERIT can be recognized with in-depth respiratory muscle monitoring as (1) an increase in gastric pressure (Pga) during expiration, resulting from expiratory muscle recruitment; (2) a drop in Pga (and hence, esophageal pressure) at the time of ventilator triggering; and (3) diaphragm electrical activity onset occurring after ventilator triggering. Future studies should focus on the incidence of ERIT and the impact in the patient receiving mechanical ventilation.Copyright © 2022 The Author(s). Published by Elsevier Inc. All rights reserved.

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