Chest
Original ResearchCritical CareMechanical Ventilation-Induced Reverse-Triggered Breaths: A Frequently Unrecognized Form of Neuromechanical Coupling
Section snippets
Materials and Methods
This study was approved by the ethics committee of Geneva University Hospital (Comité départemental d'éthique NAC, NAC 12–032R). Because of the descriptive character of the study, informed consent from the patients was not required.
Patient Characteristics
Recordings of Pes or EAdi activity were available in eight patients. All had a diagnosis of ARDS and were deeply sedated as indicated by the RASS. They were ventilated with either volume assist-control (VAC) or pressure assist-control modes. The ventilators used were Evita XL (Dräger) and Servo-I (MAQUET Holding GmbH & Co KG). An esophageal balloon was inserted into six patients with the objective of selecting ventilator settings according to lung mechanical properties. To optimize monitoring
Discussion
In this observational study, we documented the presence of respiratory entrainment in critically ill adults who were mechanically ventilated. We consecutively observed, in eight deeply sedated patients with ARDS, neural efforts entrained by the ventilator at three different ratios: 1:1, 1:2, and 1:3. We defined these neural efforts apparently triggered by the ventilator as “reverse-triggered breaths.” They occurred mainly around the transition phase from mechanical inspiration to expiration,
Conclusions
In this observational study, we documented, for the first time to our knowledge, the presence of “reverse triggering” in deeply sedated, critically ill adult patients under volume or pressure assist-control mechanical ventilation for ARDS. In the context of entrainment, “reverse-triggered” breaths constitute an unclassified and unrecognized form of patient-ventilator interaction. They can be totally overlooked, leading to erroneous assumptions regarding the patient's respiratory status. The
Acknowledgments
Author contributions: Dr Richard is the guarantor of the manuscript and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Dr Akoumianaki: contributed to the identification of the phenomenon, data recording, data analysis and interpretation, and writing of the manuscript.
Dr Lyazidi: contributed to the data collection, statistical analysis, creation of images and tables, and review of the manuscript.
Dr Rey: contributed to the recruitment of patients, data
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Funding/Support: The authors have reported to CHEST that no funding was received for this study.
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