A 56 yo man with COPD has been receiving mechanical ventilation using volume assist control for the last 36hrs. His settings are: TV 6mL/kg RR 24 FiO2 0.4 PEEP 5. His ABGs have improved to: PO2 82mmHg, PCO2 42mmHg pH 7.37 and you switch him to a pressure support mode to provide a comparable tidal volume. However, he quickly becomes dyspneic.  His ventilator graphics are shown.

Explain the graphics.

Your next maneuver should be to:

A.Provide sedation and continue current ventilator settings

B.Switch from a pressure triggering to a flow triggering system

C.Add 5cm H2O additional PEEP and titrate up to improve triggering

D.Switch to the synchronized intermittent mandatory ventilation (SIMV) mode with a backup rate of 8/min along with the pressure support

E.Return to volume assist control with backup rate of 6/min