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Inverse I:E Ratio

- normally an inspiratory to expiratory time ratio (I/E) of 1:2 is used 
- inverse I/E is also utilized in ARDS to prevent barotrauma 
- long sustained inspiration reduces mean airway pressure while increasing the PaO2 for a given FiO2; 
- despite the benefits in gas exchange, the prolonged inspiratory duration relative to expiration is uncomfortable for the alert patient, and paralysis may be required; 
- if PIP are high, one way to reduce them is to reduce the inspiratory flow rate and prolong the inspiratory time (beware of auto PEEP
- intermittent positive pressure ventilation with inspiratory time longer than expiratory time (inverse ratio ventilation) has been successfully to treat infants with ARDS