Sorry for my late answer and thanks for yours.
At our ward we are doing mostly SIMV+PSV+VL. In this case the leak around the tube was 0-5%, so I tried SIPPV+VG, but her FiO2 need increased from 0.25 to 0.4 so I returned to original way.
The next day she was accidentally extubated, what she tolerated well, so I tried on DuoPAP, but after 12 hours she developed severe CO2-retention, so dropped back to SIMV+PSV+VL. The interesting and unfortunate thing was that, she became septic after that. For stabilisation after the reintubation she needed higher pressures, like 6/20 PEEP/PIP.
A week later, sepsis cured, I started the dexamethason course again. At our ward we start usually with 0.1mg/kg/24 and after 3 days giving half of it, and after next 3 days the half of halfs. I know its not an evidence based protocol., but usually it works for us.
The next day after extubation, she had again 12 hours on DuoPAP, than back to the MV owing to several deep desaturations. But this time for good oxigenisation she needs HFOV now.
So I'm really concerned with her case. There was no significant hyperinflation on the x-rays.
@Hamed It'ts really interesting for me as well the initial A/C than HFOV mode, could you explain? Thank you!