Hi everyone, we have an 850gram neonatal Pt on a AVEA:

Settings: Mode-TCPL/AC, Rate - 60, Insp Pressure 11, Insp Time - 0.35, Flow 8, Peep 5, Fio2 40.

The patient does have periodic spells of apnea, during which the ventilator periodically “fails” to ventilate the patient. On the Main screen one can see a pressure graph, but the flow and tidal volume graph are “Flat lines’. The patient then de-saturates and goes into a Bradicardia. This makes no sense to me, isn’t the ventilator expected to "kick-in" as soon as no breath from the patient is detected? Why is this only happening occasionally? There is pressure but no flow. We changed the ventilator and the same thing happened on the second vent. The decision was made to change the patient to oscillation. The patient has also been diagnosed with Hyaline Membrane disease Grade 4. Can it be that the lung compliance is so poor that no flow goes to the lung even though pressure is generated? Please help!

What your observing is diaphragmatic braking. Stilulation, and occasional manual ventilation will improve this