Publication: Reverse Triggering Dyssynchrony 24 h after Initiation of Mechanical Ventilation
Issued Date
2021-05-01
Resource Type
ISSN
15281175
00033022
00033022
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2-s2.0-85104275499
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Mahidol University
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SCOPUS
Bibliographic Citation
Anesthesiology. Vol.134, No.5 (2021), 760-769
Suggested Citation
Ricard Mellado Artigas, L. Felipe Damiani, Thomas Piraino, Tai Pham, Lu Chen, Michela Rauseo, Irene Telias, Ibrahim Soliman, Detajin Junhasavasdikul, César Santis, Orla M. Smith, Ewan Goligher, Norman Comtois, Christer Sinderby, Leo Heunks, Laurent Brochard Reverse Triggering Dyssynchrony 24 h after Initiation of Mechanical Ventilation. Anesthesiology. Vol.134, No.5 (2021), 760-769. doi:10.1097/ALN.0000000000003726 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/78251
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Title
Reverse Triggering Dyssynchrony 24 h after Initiation of Mechanical Ventilation
Other Contributor(s)
Ramathibodi Hospital
Universite Paris-Saclay
Keenan Research Centre for Biomedical Science
Hospital Clinic Barcelona
Pontificia Universidad Católica de Chile
Toronto General Hospital
Saint Michael's Hospital University of Toronto
University of Toronto
University Health Network University of Toronto
Hopital de Bicetre
Amsterdam UMC - Free University Amsterdam
Universite Paris-Saclay
Keenan Research Centre for Biomedical Science
Hospital Clinic Barcelona
Pontificia Universidad Católica de Chile
Toronto General Hospital
Saint Michael's Hospital University of Toronto
University of Toronto
University Health Network University of Toronto
Hopital de Bicetre
Amsterdam UMC - Free University Amsterdam
Abstract
Background: Reverse triggering is a delayed asynchronous contraction of the diaphragm triggered by passive insufflation by the ventilator in sedated mechanically ventilated patients. The incidence of reverse triggering is unknown. This study aimed at determining the incidence of reverse triggering in critically ill patients under controlled ventilation. Methods: In this ancillary study, patients were continuously monitored with a catheter measuring the electrical activity of the diaphragm. A method for automatic detection of reverse triggering using electrical activity of the diaphragm was developed in a derivation sample and validated in a subsequent sample. The authors assessed the predictive value of the software. In 39 recently intubated patients under assist-control ventilation, a 1-h recording obtained 24 h after intubation was used to determine the primary outcome of the study. The authors also compared patients' demographics, sedation depth, ventilation settings, and time to transition to assisted ventilation or extubation according to the median rate of reverse triggering. Results: The positive and negative predictive value of the software for detecting reverse triggering were 0.74 (95% CI, 0.67 to 0.81) and 0.97 (95% CI, 0.96 to 0.98). Using a threshold of 1 μV of electrical activity to define diaphragm activation, median reverse triggering rate was 8% (range, 0.1 to 75), with 44% (17 of 39) of patients having greater than or equal to 10% of breaths with reverse triggering. Using a threshold of 3 μV, 26% (10 of 39) of patients had greater than or equal to 10% reverse triggering. Patients with more reverse triggering were more likely to progress to an assisted mode or extubation within the following 24 h (12 of 39 [68%]) vs. 7 of 20 [35%]; P = 0.039). Conclusions: Reverse triggering detection based on electrical activity of the diaphragm suggests that this asynchrony is highly prevalent at 24 h after intubation under assist-control ventilation. Reverse triggering seems to occur during the transition phase between deep sedation and the onset of patient triggering.