Frequency and Risk Factors for Reverse Triggering in Pediatric Acute Respiratory Distress Syndrome during Synchronized Intermittent Mandatory Ventilation
| Autor: | Tatsutoshi Shimatani, Justin Hotz, Robinder G. Khemani, Benjamin Yoon, Miyako Kyogoku, Christopher J. L. Newth, Shinichiro Ohshimo, Michihito Kyo, Nobuaki Shime |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty business.industry digestive oral and skin physiology Acute respiratory distress Lung injury 03 medical and health sciences Synchronized intermittent mandatory ventilation 0302 clinical medicine 030228 respiratory system Emergency medicine medicine Respiratory effort 030212 general & internal medicine business Patient ventilator asynchrony Original Research |
| Zdroj: | Ann Am Thorac Soc |
| Popis: | Rationale: Reverse triggering (RT) occurs when respiratory effort begins after a mandatory breath is initiated by the ventilator. RT may exacerbate ventilator-induced lung injury and lead to breath stacking. Objectives: We sought to describe the frequency and risk factors for RT among patients with acute respiratory distress syndrome (ARDS) and identify risk factors for breath stacking. Methods: We performed a secondary analysis of physiologic data from children on synchronized intermittent mandatory pressure-controlled ventilation enrolled in a single-center randomized controlled trial for ARDS. When children had a spontaneous effort on esophageal manometry, waveforms were recorded and independently analyzed by two investigators to identify RT. Results: We included 81,990 breaths from 100 patient-days and 36 patients. Overall, 2.46% of breaths were RTs, occurring in 15/36 patients (41.6%). A higher tidal volume and a minimal difference between neural respiratory rate and set ventilator rate were independently associated with RT (P = 0.001) in multivariable modeling. Breath stacking occurred in 534 (26.5%) of 2,017 RT breaths and in 14 (93.3%) of 15 patients with RT. In multivariable modeling, breath stacking was more likely to occur when total airway Δpressure (peak inspiratory pressure − positive end-expiratory pressure [PEEP]) at the time patient effort began, peak inspiratory pressure, PEEP, and Δpressure were lower and when patient effort started well after the ventilator-initiated breath (higher phase angle) (all P 25% of the time. Clinical trial registered with ClinicalTrials.gov (NCT03266016). |
| Databáze: | OpenAIRE |
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