Mechanical Ventilation-Induced Reverse-Triggered Breaths

Akoumianaki, Evangelia; Lyazidi, Aissam; Rey, Nathalie; Matamis, Dimitrios; Perez-Martinez, Nelly; Giraud, Raphaël; Mancebo, Jordi; Brochard, Laurent; Richard, Jean-Christophe M.

doi:10.1378/chest.12-1817

Cited by 238 publications

(87 citation statements)

References 28 publications

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“…Reverse triggering was defined as neural efforts triggered by mandatory breath of ventilator [3]. It is easily overlooked [3,4].…”

Section: Discussionmentioning

confidence: 99%

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Electrical Activity of the Diaphragm During Reverse Triggering - A Case Report

Ueno¹,

Itagaki²,

Onodera³

et al. 2017

J Clin Case Rep

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Reverse triggering is defined as diaphragmatic muscle contraction triggered by mandatory breath of ventilator. Reverse triggering induced double cycling and large tidal volume (V T ) in Pressure Control Ventilation (PCV).An 81-year-old male was admitted to the ICU after tricuspid valve plasty. A close observation of graphic monitor showed a deflection of pressure waveform in the middle of mandatory breath. Electric activity of the diaphragm (EAdi) revealed diaphragmatic contraction following mandatory breath. When diaphragmatic contraction started at the end of mandatory breath it induced double-cycling. When it started at the middle of mandatory breath V T increased. As spontaneous breathing increased, reverse triggering disappeared. While the consequences of reverse triggering are under discussion, in our case it led double cycling and large V T , and it might be injurious. We should recognize it is more common than expected.

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“…Reverse triggering was defined as neural efforts triggered by mandatory breath of ventilator [3]. It is easily overlooked [3,4].…”

Section: Discussionmentioning

confidence: 99%

“…Reverse triggering is diaphragmatic muscle contraction triggered by mandatory breath and it is frequently overlooked [3]. It induces undesirable effects such as increased work of breathing and large tidal volume (V T ) [4].…”

Section: Introductionmentioning

confidence: 99%

Electrical Activity of the Diaphragm During Reverse Triggering - A Case Report

Ueno¹,

Itagaki²,

Onodera³

et al. 2017

J Clin Case Rep

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“…The NeuroSync index provides better distinction for the degrees of patient-ventilator interaction by classifying events falling inside the box as synchrony, outside the box as dyssynchrony, and the remainder as asynchrony. Strong ICCs for test-retest, inter-rater, and inter-method reliability suggest that the NeuroSync index and automated detection method are both valid and reliable [9]. …”

Section: Discussionmentioning

confidence: 99%

An automated and standardized neural index to quantify patient-ventilator interaction

et al. 2013

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IntroductionThe aim of this study was to validate an automated, objective and standardized algorithm for quantifying and displaying patient-ventilator interaction.MethodsUsing a new method to detect patient-ventilator synchrony, the present study re-analyzed previously acquired and published data from 24 mechanically ventilated adult patients (Colombo et al., Crit Care Med. 2011 Nov;39(11):2452–7). Patient-ventilator interactions were evaluated by comparing ventilator pressure and diaphragm electrical activity (EAdi) waveforms, recorded during pressure support ventilation. The EAdi and ventilator pressure waveforms were analyzed for their timings (manually and automatically determined), and the error between the two waveforms was quantified. A new index of patient-ventilator interaction (NeuroSync index), which is standardized and automated, was validated and compared to manual analysis and previously published indices of asynchrony.ResultsThe comparison of manual and automated detection methods produced high test-retest and inter-rater reliability (Intraclass correlation coefficient = 0.95). The NeuroSync index increased the sensitivity of detecting dyssynchronies, compared to previously published indices, which were found to only detect asynchronies.ConclusionThe present study introduces an automated method and the NeuroSync index to determine patient-ventilator interaction with a more sensitive analysis method than those previously described. A dashboard-style of graphical display allows a rapid overview of patient-ventilator interaction and breathing pattern at the bedside.

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“…Finally, a recent paper has described the presence of reverse triggering in deeply sedated patients during controlled mechanical ventilation [59]. This phenomenon is caused by the diaphragmatic muscle contractions triggered by ventilator insufflations.…”

Section: Transpulmonary Pressure To Guide Mechanical Ventilation In Ardsmentioning

confidence: 99%

Transpulmonary pressure monitoring during mechanical ventilation: a bench-to-bedside review

Mietto

Malbrain

Chiumello³

2015

Anaesthesiol Intensive Ther

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Different ventilation strategies have been suggested in the past in patients with acute respiratory distress syndrome (ARDS). Airway pressure monitoring alone is inadequate to assure optimal ventilatory support in ARDS patients. The assessment of transpulmonary pressure (P TP ) can help clinicians to tailor mechanical ventilation to the individual patient needs. Transpulmonary pressure monitoring, defined as airway pressure (P aw ) minus intrathoracic pressure (ITP), provides essential information about chest wall mechanics and its effects on the respiratory system and lung mechanics. The positioning of an esophageal catheter is required to measure the esophageal pressure (P eso ), which is clinically used as a surrogate for ITP or pleural pressure (P pl ), and calculates the transpulmonary pressure. The benefits of such a ventilation approach are avoiding excessive lung stress and individualizing the positive end-expiratory pressure (PEEP) setting. The aim is to prevent over-distention of alveoli and the cyclic recruitment/derecruitment or shear stress of lung parenchyma, mechanisms associated with ventilator-induced lung injury (VILI). Knowledge of the real lung distending pressure, i.e. the transpulmonary pressure, has shown to be useful in both controlled and assisted mechanical ventilation. In the latter ventilator modes, P eso measurement allows one to assess a patient's respiratory effort, patient-ventilator asynchrony, intrinsic PEEP and the calculation of work of breathing. Conditions that have an impact on P eso, such as abdominal hypertension, will also be discussed briefly.

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Mechanical Ventilation-Induced Reverse-Triggered Breaths

Cited by 238 publications

References 28 publications

Electrical Activity of the Diaphragm During Reverse Triggering - A Case Report

Electrical Activity of the Diaphragm During Reverse Triggering - A Case Report

An automated and standardized neural index to quantify patient-ventilator interaction

Transpulmonary pressure monitoring during mechanical ventilation: a bench-to-bedside review

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