Atypical patterns of breathing in critically ill: adjuncts to prognostication?

We present a case of an uncommon type of breathing witnessed in a mechanically ventilated 11-year-old child who presented following sudden loss of consciousness. He was found to have a large diffuse sub-arachnoid haemorrhage which was not amenable to surgical intervention. Thus, neuroprotective ventilation was continued. Sedation was withheld 48 hours later, to assess the Glasgow coma scale (GCS). His arterial O 2 and CO 2 tensions, acid-base status, electrolytes, glycaemic levels and other metabolic parameters were optimized. Another 72 hours later, with a respiratory trigger of 1 l/min, on synchronized-intermittent mandatory ventilatory mode, a peculiar type of spontaneous breathing