Publication:
Automated detection and quantification of reverse triggering effort under mechanical ventilation

Issued Date

2021-12-01

Resource Type

Article

ISSN

1466609X
13648535

DOI

10.1186/s13054-020-03387-3

Other identifier(s)

2-s2.0-85101431466

Rights

Mahidol University

Rights Holder(s)

SCOPUS

Bibliographic Citation

Critical Care. Vol.25, No.1 (2021)

Suggested Citation

Tài Pham, Jaume Montanya, Irene Telias, Thomas Piraino, Rudys Magrans, Rémi Coudroy, L. Felipe Damiani, Ricard Mellado Artigas, Matías Madorno, Lluis Blanch, Laurent Brochard, Tài Pham, Jaume Montanya, Rémi Coudroy, L. Felipe Damiani, Lluis Blanch, Laurent Brochard, Cesar Santis, Tommaso Mauri, Elena Spinelli, Giacomo Grasselli, Savino Spadaro, Carlo Alberto Volta, Francesco Mojoli, Dimitris Georgopoulos, Eumorfia Kondili, Stella Soundoulounaki, Tobias Becher, Norbert Weiler, Dirk Schaedler, Oriol Roca, Manel Santafe, Jordi Mancebo, Leo Heunks, Heder de Vries, Chang Wen Chen, Jian Xin Zhou, Guang Qiang Chen, Nuttapol Rittayamai, Norberto Tiribelli, Sebastian Fredes, Carlos Ferrando Ortolá, François Beloncle, Alain Mercat, J. M. Arnal, J. L. Diehl, A. Demoule, M. Dres, S. Jochmans, J. Chelly, Nicolas Terzi, Claude Guérin, E. Baedorf Kassis, J. Beitler, Davide Chiumello, Erica Ferrari Luca Bolgiaghi, V. Fanelli, J. E. Alphonsine, Arnaud W. Thille, Laurent Papazian Automated detection and quantification of reverse triggering effort under mechanical ventilation. Critical Care. Vol.25, No.1 (2021). doi:10.1186/s13054-020-03387-3 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/77628

Research Projects

Organizational Units

Authors

Journal Issue

Thesis

Title

Automated detection and quantification of reverse triggering effort under mechanical ventilation

Author(s)

Tài Pham
 Jaume Montanya
 Irene Telias
 Thomas Piraino
 Rudys Magrans
 Rémi Coudroy
 L. Felipe Damiani
 Ricard Mellado Artigas
 Matías Madorno
 Lluis Blanch
 Laurent Brochard
 Tài Pham
 Jaume Montanya
 Rémi Coudroy
 L. Felipe Damiani
 Lluis Blanch
 Laurent Brochard
 Cesar Santis
 Tommaso Mauri
 Elena Spinelli
 Giacomo Grasselli
 Savino Spadaro
 Carlo Alberto Volta
 Francesco Mojoli
 Dimitris Georgopoulos
 Eumorfia Kondili
 Stella Soundoulounaki
 Tobias Becher
 Norbert Weiler
 Dirk Schaedler
 Oriol Roca
 Manel Santafe
 Jordi Mancebo
 Leo Heunks
 Heder de Vries
 Chang Wen Chen
 Jian Xin Zhou
 Guang Qiang Chen
 Nuttapol Rittayamai
 Norberto Tiribelli
 Sebastian Fredes
 Carlos Ferrando Ortolá
 François Beloncle
 Alain Mercat
 J. M. Arnal
 J. L. Diehl
 A. Demoule
 M. Dres
 S. Jochmans
 J. Chelly
 Nicolas Terzi
 Claude Guérin
 E. Baedorf Kassis
 J. Beitler
 Davide Chiumello
 Erica Ferrari Luca Bolgiaghi
 V. Fanelli
 J. E. Alphonsine
 Arnaud W. Thille
 Laurent Papazian

Other Contributor(s)

Institut d’Investigació i Innovació Parc Taulí (I3PT)
 Siriraj Hospital
 Vall d'Hebron Institut de Recerca
 Universite Paris-Saclay
 Centro de Investigación Biomédica en Red de Enfermedades Respiratorias
 Keenan Research Centre for Biomedical Science
 IRCCS Fondazione Mondino
 Sanatorio de la Trinidad
 Beijing Tiantan Hospital, Capital Medical University
 Churruca Visca Hospital
 Universite de Poitiers
 McMaster University
 Università degli Studi di Milano
 Hospital Clinic Barcelona
 Pontificia Universidad Católica de Chile
 University of Ferrara
 AP-HP Assistance Publique - Hopitaux de Paris
 Centre Hospitalier Universitaire de Poitiers
 Instituto Tecnológico de Buenos Aires (ITBA)
 Saint Michael's Hospital University of Toronto
 University of Toronto
 Hôpital Universitaire Pitié Salpêtrière
 University Health Network University of Toronto
 Hôpital Nord AP-HM
 Università degli Studi di Torino
 Vagelos College of Physicians and Surgeons
 Heraklion University Hospital
 Hospital de La Santa Creu I Sant Pau
 CHU Angers
 Centre Hospitalier Universitaire de Grenoble
 Universitätsklinikum Schleswig-Holstein Campus Kiel
 National Cheng Kung University College of Medicine
 Harvard Medical School
 Amsterdam UMC
 Sinai Health System
 Hôpital Sainte Musse
 BetterCare S.L
 Centre Hospitalier de Melun

Abstract

Background: Reverse triggering (RT) is a dyssynchrony defined by a respiratory muscle contraction following a passive mechanical insufflation. It is potentially harmful for the lung and the diaphragm, but its detection is challenging. Magnitude of effort generated by RT is currently unknown. Our objective was to validate supervised methods for automatic detection of RT using only airway pressure (Paw) and flow. A secondary objective was to describe the magnitude of the efforts generated during RT. Methods: We developed algorithms for detection of RT using Paw and flow waveforms. Experts having Paw, flow and esophageal pressure (Pes) assessed automatic detection accuracy by comparison against visual assessment. Muscular pressure (Pmus) was measured from Pes during RT, triggered breaths and ineffective efforts. Results: Tracings from 20 hypoxemic patients were used (mean age 65 ± 12 years, 65% male, ICU survival 75%). RT was present in 24% of the breaths ranging from 0 (patients paralyzed or in pressure support ventilation) to 93.3%. Automatic detection accuracy was 95.5%: sensitivity 83.1%, specificity 99.4%, positive predictive value 97.6%, negative predictive value 95.0% and kappa index of 0.87. Pmus of RT ranged from 1.3 to 36.8 cmH20, with a median of 8.7 cmH20. RT with breath stacking had the highest levels of Pmus, and RTs with no breath stacking were of similar magnitude than pressure support breaths. Conclusion: An automated detection tool using airway pressure and flow can diagnose reverse triggering with excellent accuracy. RT generates a median Pmus of 9 cmH2O with important variability between and within patients. Trial registration: BEARDS, NCT03447288.[Figure not available: see fulltext.]

Keyword(s)

Medicine

Availability

URI

https://repository.li.mahidol.ac.th/handle/20.500.14594/77628

Collections

Scopus 2021