Automatic detection of ineffective triggering and double triggering during mechanical ventilation

Mulqueeny, Qestra; Ceriana, Piero; Carlucci, Annalisa; Fanfulla, Francesco; Delmastro, Monica; Nava, Stefano

doi:10.1007/s00134-007-0767-z

Cited by 87 publications

(78 citation statements)

References 11 publications

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“…While home ventilators can adequately compensate large gas leaks, ICU ventilators are not able to cope with large leaks and need to titrate trigger sensitivity to avoid auto-triggering and asynchrony between patient and ventilator [135][136][137]. Indeed, the presence of asynchrony represents one of the main problems with NPPV both during ARF episodes [138] and in long-term ventilation for chronic respiratory insufficiency [139]. In this regard, the recording of breathing frequency using the ventilator monitor may be misleading.…”

Section: Leaks and Ventilators: Icu Versus Homementioning

confidence: 99%

Noninvasive positive pressure ventilation in the acute care setting: where are we?

Ambrosino¹,

Vagheggini²

2008

European Respiratory Journal

169

128

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Noninvasive positive pressure ventilation (NPPV) is a technique used to deliver mechanical ventilation that is increasingly utilised in acute and chronic conditions. The present review examines the evidence supporting the use of NPPV in acute respiratory failure (ARF) due to different conditions. Strong evidence supports the use of NPPV for ARF to prevent endotracheal intubation (ETI), as well as to facilitate extubation in patients with acute exacerbations of chronic obstructive pulmonary disease and to avoid ETI in acute cardiogenic pulmonary oedema, and in immunocompromised patients. Weaker evidence supports the use of NPPV for patients with ARF due to asthma exacerbations, with post-operative or post-extubation ARF, pneumonia, acute lung injury, acute respiratory distress syndrome, or during bronchoscopy. NPPV should be applied under close clinical and physiological monitoring for signs of treatment failure and, in such cases, ETI should be promptly available. A trained team, careful patient selection and optimal choice of devices can optimise outcome of NPPV.Noninvasive positive pressure ventilation is increasingly being used in the management of acute respiratory failure but caregivers must respect evidence-supported indications and avoid contraidincations. Additionally, the technique must be applied in the appropriate location by a trained team in order to avoid disappointing results.

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Section: Leaks and Ventilators: Icu Versus Homementioning

confidence: 99%

Noninvasive positive pressure ventilation in the acute care setting: where are we?

Ambrosino¹,

Vagheggini²

2008

European Respiratory Journal

169

128

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“…Recently, a parallel approach was developed by Mulqueeny et al [18]. They built an algorithm that was able to detect ineffective triggering efforts based on significant alterations of the expiratory flow signal.…”

Section: Discussionmentioning

confidence: 99%

A Noninvasive Method to Identify Ineffective Triggering in Patients with Noninvasive Pressure Support Ventilation

et al. 2009

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Background: Ineffective inspiratory triggering efforts are a major cause of poor patient-ventilator interactions during mechanical ventilation, but their routine identification requires the insertion of an esophageal catheter. Objectives: We developed a mathematical analysis of ventilatory tracings recorded under noninvasive pressure ventilation in order to identify ineffective triggering efforts and their consequences without recording esophageal pressure. Methods: We assessed 2,183 cycles from 44 pressure support tracings in 14 children with cystic fibrosis treated by noninvasive home ventilation. Airway pressure, flow and esophageal pressure time series were visually analyzed and manually counted. Airway pressure versus time and flow versus time were then analyzed using a dedicated algorithm written by us. Esophageal pressure was only used for validation. Results: A mathematical treatment of flow time series allowed us to draw phase portraits that had specific periodic trajectories for triggered ventilatory cycles and ineffective triggering efforts. From flow and pressure tracings, our algorithm correctly identified 100% of triggered cycles and 53/56 (94.6%) of ineffective triggering efforts. Ineffective triggering was associated with a significant reduction in minute ventilation, inspiratory flows and a significant increase in inspiratory efforts. Conclusions: A noninvasive analysis of flow and airway pressure can reliably identify ineffective triggering efforts during noninvasive pressure support ventilation. This approach may be a valuable tool for evaluating patient-ventilator interactions and their consequences during long-term recordings.

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“…More recently, several investigators have explored the use of machine learning and pattern recognition to automatically detect asynchrony. [63][64][65][66][67] In most instances these systems specifically address the issue of missed triggers. Chen et al used measurements of flow and pressure deflections to detect missed triggers in 14 mechanically ventilated patients.…”

Section: Automated Detection Of Asynchronymentioning

confidence: 99%

“…63 Mulqueeney and others have shown that pattern recognition software can detect missed triggers during the expiratory phase with an overall accuracy of near 95%. 64,65 More recently, Blanch and colleagues have evaluated the Better Care system for detection of missed triggers during invasive ventilation. 66 The Better Care software calculates a theoretical mono-exponential expiratory flow curve and compares it to the actual expiratory flow curve by evaluating the percentage deviation.…”

Section: Automated Detection Of Asynchronymentioning

confidence: 99%

Asynchrony and DyspneaDiscussion

2013

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SummaryPatient-ventilator synchrony and patient comfort are assumed to go hand in hand, yet few studies provide support for this common sense idea. In reality, synchrony between the patient and ventilator is complex and can be affected by the ventilator settings, type of ventilator, patient-ventilator interface, and sedation. Inspections of airway pressure and flow waveforms are reliable methods for detecting asynchrony, and automated detection seems accurate. A number of types of asynchronies have been defined, and asynchrony during invasive and noninvasive ventilation have different calling cards. There is a clear association between asynchrony, ventilator-induced diaphragmatic dysfunction, and duration of mechanical ventilation. Whether these are cause and effect or simply associated remains to be determined.

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Automatic detection of ineffective triggering and double triggering during mechanical ventilation

Cited by 87 publications

References 11 publications

Noninvasive positive pressure ventilation in the acute care setting: where are we?

Noninvasive positive pressure ventilation in the acute care setting: where are we?

A Noninvasive Method to Identify Ineffective Triggering in Patients with Noninvasive Pressure Support Ventilation

Asynchrony and DyspneaDiscussion

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