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(a) Waterfall phenomenon-negative pressure required to trigger the ventilator breath is reduced on application of external positive end-expiratory pressure, (b) effect of applied positive end-expiratory pressure on triggering-extrinsic positive end-expiratory pressure of 5 cm H2O reduces the work of breathing from level A to level B by offsetting the auto-positive end-expiratory pressure in this chronic obstructive pulmonary disease patient with trigger sensitivity of 2 cm H2O
