Patient–Ventilator Asynchrony due to Reverse Triggering Occurring in Brain-Dead Patients: Clinical Implications and Physiological Meaning

Delisle, Stéphane; Charbonney, Emmanuel; Albert, Martin; Ouellet, Paul; Marsolais, Pierre; Rigollot, Marceau; Savary, Dominique; Richard, Jean-Christophe M.; Serri, Karim

doi:10.1164/rccm.201603-0483le

Cited by 37 publications

(19 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It has been reported that neural efforts could be entrained by the ventilator in different entrainment ratios, namely the patient's effort induced by one (1:1), two (1:2), or three (1:3) time-initiated inspirations (1,5). In the present case, reverse triggering occurred periodically at a fixed 1:1 ratio during entrainment periods (Figure 1).…”

Section: Patient-ventilator Asynchrony Is Prevalent During Mechanicalsupporting

confidence: 50%

“…The pathophysiological mechanisms of reverse triggering remain unclear. The Hering-Breuer reflexes, vagal nervous fibers, and cortical and subcortical influences seem to be responsible for neural inspiratory efforts entrained by the ventilator (5). In our patient, all reverse-triggered breaths were induced by the time-initiated cycles, while no entrainment occurred during the patient-triggered cycles.…”

Section: Patient-ventilator Asynchrony Is Prevalent During Mechanicalmentioning

confidence: 51%

“…The patient was then switched to pressure support ventilation and was weaned on the ninth day. (5). To date, this type of asynchrony has been seldom reported and may frequently be unrecognized in mechanically ventilated patients.…”

Section: Case Reportmentioning

confidence: 99%

“…Previous studies have reported that patient-ventilator asynchrony is associated with adverse outcomes including prolonged duration of ventilation and length of stay in the intensive care unit and increased mortality (2)(3)(4). Reverse triggering may also generate higher plateau pressure, large tidal volume, and transpulmonary pressure swings (1,5). Monitoring of esophageal pressure or the electrical activity of the diaphragm can help diagnose reverse triggering (6,7).…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Detection of reverse triggering in a 55-year-old man under deep sedation and controlled mechanical ventilation

He¹,

Luo²,

Chen³

et al. 2018

J. Thorac. Dis

View full text Add to dashboard Cite

Section: Patient-ventilator Asynchrony Is Prevalent During Mechanicalsupporting

confidence: 50%

Section: Patient-ventilator Asynchrony Is Prevalent During Mechanicalmentioning

confidence: 51%

Section: Case Reportmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Detection of reverse triggering in a 55-year-old man under deep sedation and controlled mechanical ventilation

He¹,

Luo²,

Chen³

et al. 2018

J. Thorac. Dis

View full text Add to dashboard Cite

“…Because the patient's inspiratory muscles are still active at the beginning of expiration, impeding the elastic recoil of the respiratory system from increasing alveolar pressure, the peak expiratory flow is markedly reduced. 27 When the patient's effort is sufficiently deep and long, the decrease in airway pressure can trigger a second ventilator breath with a nil or very short expiratory time [26][27][28] (Fig. 2).…”

Section: Types Of Asynchroniesmentioning

confidence: 99%

Minimizing Asynchronies in Mechanical Ventilation: Current and Future Trends

et al. 2018

View full text Add to dashboard Cite

Patient-ventilator asynchrony exists when the phases of breath delivered by the ventilator do not match those of the patient. Asynchronies occur throughout mechanical ventilation and negatively affect patient comfort, duration of mechanical ventilation, length of ICU stays, and mortality. Identifying asynchronies requires careful attention to patients and their ventilator waveforms. This review discusses the different types of asynchronies, how they are generated, and their impact on patient comfort and outcome. Moreover, it discusses practical approaches for detecting, correcting, and preventing asynchronies. Current evidence suggests that the best approach to managing asynchronies is by adjusting ventilator settings. Proportional modes improve patient-ventilator coupling, resulting in greater comfort and less dyspnea, but not in improved outcomes with respect to the duration of mechanical ventilation, delirium, or cognitive impairment. Advanced computational technologies will allow smart alerts, and models based on time series of asynchronies will be able to predict and prevent asynchronies, making it possible to tailor mechanical ventilation to meet each patient's needs throughout the course of mechanical ventilation.

show abstract