Auto-triggering phenomenon secondary to the artificial pulsatility of continuous-Flow left ventricular assist device

The intermittent ejection created by this artificial pulse may be sufficient to lead to change of arterial blood flow, subsequent change in venous return and right ventricular ejection, and then intrathoracic pressure change to cause auto-triggering (Fig. 1, Panel A, black arrow). [...]interventions include: (1) looking for reversible causes, such as condensation or circuit leaks, (2) increasing the threshold sensitivity of the flow-trigger incrementally until auto-triggering is eliminated; (4) switching from flow-triggering to the less sensitive pressure-triggering setting; (5) optimizing the level of applied PEEP, which results in less fluctuation in airway flows (in flow-triggering) and airway pressures (in pressure-triggering) modes, and hence decreases the sensitivity for patient-triggered breaths [2–4]. Awareness of the potential auto-triggering feature of the newer generation continuous-flow LVADs is essential for clinicians to increase its early detection, timely intervention and prevent unnecessary administration of narcotics and/or muscle relaxant.