Ineffective triggering is a common problem early in the course of MV and is associated with increased morbidity, including longer MV duration, shorter VFS, longer length of stay, and lower likelihood of home discharge.
Purpose
Clinicians frequently administer sedation to facilitate mechanical ventilation. The purpose of this study was to examine the relationship between sedation level and patient-ventilator asynchrony.
Materials and Methods
Airway pressure and airflow were recorded for 15 minutes. Patient-ventilator asynchrony was assessed by determining the number of breaths demonstrating ineffective triggering, double triggering, short cycling, and prolonged cycling. Ineffective triggering index (ITI) was calculated by dividing the number of ineffectively triggered breaths by the total number of breaths (triggered and ineffectively triggered). Sedation level was assessed by 3 methods: Richmond Agitation-Sedation Scale (RASS), awake (yes or no), and delirium (CAM-ICU).
Results
Twenty medical intensive care unit patients underwent 35 observations. Ineffective triggering was seen in 17 of 20 patients and was the most frequent asynchrony (88% of all asynchronous breaths), being observed in 9 ± 12% of breaths. Deeper levels of sedation were associated with increasing ITI (Awake: yes 2% versus no 11% p = 0.05; CAM-ICU: coma 15% versus delirium 5% versus no delirium 2%, p < 0.05; RASS: 0, 0% versus −5, 15%, p < 0.05). Diagnosis of chronic obstructive pulmonary disease, sedative type or dose, mechanical ventilation mode, trigger method had no effect on ITI.
Conclusions
Asynchrony is common, and deeper sedation level is a predictor of ineffective triggering.
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