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Vent control

Delayed cycling

Suspect delayed cycling when mechanical inspiration appears to continue after the patient’s neural inspiration ends. A late pressure rise or end-inspiratory no-flow segment can be a clue, but waveform appearance alone is not definitive.

Adjust inspiratory time or cyclingMode-specific timing controls.Assess comfort and drivePain/awareness may coexist but timing still needs correction.

Possible delayed-cycling clue

Possible delayed-cycling clue

A late pressure rise or end-inspiratory no-flow segment can suggest delayed cycling, but confirm with patient examination, mode, timing, and ventilator context.

Original Airway of the Month teaching diagrams redrawn from standard ventilator scalar and loop conventions. Interpretation is anchored to the AARC 2024 Patient–Ventilator Assessment guideline, the peer-reviewed Basics of Ventilator Waveforms review, the 2026 SYNAPsE asynchrony consensus, and the University of Pennsylvania Ventilator Overview and Troubleshooting tip sheet. Waveforms are pattern-recognition aids, not diagnoses; display colors, labels, and orientation vary by ventilator brand.

Confirm before changing settings

  • Look for a reproducible mismatch between patient effort and ventilator cycling rather than relying on a single waveform shape.
  • Review mode, inspiratory time, flow, cycling threshold, patient effort, respiratory drive, pain, and sedation with RT.

Fix ideas

  • If delayed cycling is confirmed, shorten inspiratory time in time-cycled modes.
  • In pressure support, adjust the expiratory cycling threshold as ventilator-specific controls allow.
  • Reassess VT, comfort, work of breathing, and waveform after the change.

Evidence and use limits

Last reviewed: 2026-07-17. Designed for: emergency medicine learners, clinicians, EMS, RT, and airway educators.

This is an educational cognitive aid, not a bedside order set. Confirm medications, ventilator changes, pediatric dosing, procedures, and escalation decisions against the patient’s physiology, the ventilator in use, and local ED/ICU/anesthesia/pharmacy/RT/EMS/pediatric policy.

Full references · Editorial policy · AARC 2024 ventilator assessment · ATS/ESICM/SCCM lung-protective ventilation · ATS 2024 ARDS update

About this resource
Created by: Andrew Pirotte, MD; Kyle Brown, MD; Reba Hodge, MD; Amanda Vanderwerf, PharmD, BCEMP; Morgan Kimball, PharmD, BCEMP; Joshua Mohess Clinical review: Emergency medicine faculty review completed. Medication content reviewed by Amanda Vanderwerf, PharmD, BCEMP, and Morgan Kimball, PharmD, BCEMP. Last reviewed: 2026-07-23 Next scheduled review: 2027-01-23 Designed for: EM residents, emergency physicians, EMS clinicians, airway educators, and simulation faculty Important: Educational resource and cognitive-aid guide only; not a bedside order set or substitute for local protocol, medical direction, or clinical judgment. Website contact: [email protected]