Refractory ineffective triggering during pressure support ventilation: effect of proportional assist ventilation with load-adjustable gain factors - 08/01/26
, Tommaso Maraffi 2, 4, Samuel Tuffet 1, 2, 3, François Perier 1, 2, Nicolas de Prost 1, 2, Keyvan Razazi 1, 2, Armand Mekontso Dessap 1, 2, Guillaume Carteaux 1, 2, 3
Bienvenue sur EM-consulte, la référence des professionnels de santé.
Article gratuit.
Connectez-vous pour en bénéficier!
Abstract |
Background |
Ineffective triggering is frequent during pressure support ventilation (PSV) and may persist despite ventilator adjustment, leading to refractory asynchrony. We aimed to assess the effect of proportional assist ventilation with load-adjustable gain factors (PAV+) on the occurrence of refractory ineffective triggering.
Design |
Observational assessment followed by prospective cross-over physiological study.
Setting |
Academic medical ICU.
Patients |
Ineffective triggering was detected during PSV by a twice-daily inspection of the ventilator’s screen. The impact of pressure support level (PSL) adjustments on the occurrence of asynchrony was recorded. Patients experiencing refractory ineffective triggering, defined as persisting asynchrony at the lowest tolerated PSL, were included in the physiological study.
Interventions |
Physiological study: Flow, airway, and esophageal pressures were continuously recorded during 10 min under PSV with the lowest tolerated PSL, and then under PAV+ with the gain adjusted to target a muscle pressure between 5 and 10 cmH 2 O.
Measurements |
Primary endpoint was the comparison of asynchrony index between PSV and PAV+ after PSL and gain adjustments.
Results |
Among 36 patients identified having ineffective triggering under PSV, 21 (58%) exhibited refractory ineffective triggering. The lowest tolerated PSL was higher in patients with refractory asynchrony as compared to patients with non-refractory ineffective triggering. Twelve out of the 21 patients with refractory ineffective triggering were included in the physiological study. The median lowest tolerated PSL was 17 cmH 2 O [12–18] with a PEEP of 7 cmH 2 O [5–8] and FiO 2 of 40% [39–42]. The median gain during PAV+ was 73% [65–80]. The asynchrony index was significantly lower during PAV+ than PSV (2.7% [1.0–5.4] vs . 22.7% [10.3–40.1], p < 0.001) and consistently decreased in every patient with PAV+. Esophageal pressure–time product (PTPes) did not significantly differ between the two modes (107 cmH 2 O/s/min [79–131] under PSV vs . 149 cmH 2 O/s/min [129–170] under PAV+, p = 0.092), but the proportion of PTPes lost in ineffective triggering was significantly lower with PAV+ (2 cmH 2 O/s/min [1–6] vs . 8 cmH 2 O/s/min [3–30], p = 0.012).
Conclusions |
Among patients with ineffective triggering under PSV, PSL adjustment failed to eliminate asynchrony in 58% of them (21 of 36 patients). In these patients with refractory ineffective triggering, switching from PSV to PAV+ significantly reduced or even suppressed the incidence of asynchrony.
Le texte complet de cet article est disponible en PDF.Keywords : Mechanical ventilation, Patient, Ventilator asynchrony, Ineffective triggering, Proportional assist ventilation
Plan
Vol 11 - N° 1
Article 147- 2021 Retour au numéro
Article précédent
- Transesophageal echocardiography for cardiovascular risk estimation in patients with sepsis and new-onset atrial fibrillation: a multicenter prospective pilot study
- Vincent Labbé, Stephane Ederhy, Nathanael Lapidus, Jérémie Joffre, Keyvan Razazi, Laurent Laine, Oumar Sy, Sebastian Voicu, Frank Chemouni, Nadia Aissaoui, Roland Smonig, Denis Doyen, Fabrice Carrat, Guillaume Voiriot, Armand Mekontso-Dessap, Ariel Cohen, Muriel Fartoukh, for the FAST Study Group, Bertrand Guidet, Hafid Ait-Oufella, Simon Bourcier, Daniel Da Silva, Sebastien Jochmans, Jean Dellamonica, Jean-François Timsit, Bruno Megarbane, Jean-Luc Diehl, Sophie Rushton-Smith
- Incidence, clinical characteristics, and outcome after unexpected cardiac arrest among critically ill adults with COVID-19: insight from the multicenter prospective ACICOVID-19 registry
- Jonathan Chelly, Gaetan Plantefève, Toufik Kamel, Cédric Bruel, Saad Nseir, Christopher Lai, Giulia Cirillo, Elena Skripkina, Sébastien Ehrminger, Fernando-Daniel Berdaguer-Ferrari, Julien Le Marec, Marine Paul, Aurélie Autret, Nicolas Deye, the ACICOVID-19 study group, Jean-Michel Arnal, Julio Badie, Audrey Berric, Jennifer Brunet, Thibault Bertrand, Dorothée Carpentier, Karim Chaoui, Anaïs Chapelle, Riad Chelha, Gaëlle Corno, Cédric Daubin, Richard Descamps, Alexandre Demoule, Stéphanie Deryckere, Stephane-Yannis Donati, Laurent Ducros, Nathalie Embriaco, Nicolas Engrand, Camille Foucault, Sean Anthony Freeman, Santiago Freita Ramos, Arnaud Galbois, Aude Garnero, Cyrille Geay, Laurent Guérin, Vivien Hong Tuan Ha, Thomas Hullin, Sébastien Jochmans, Michel Kaidomar, Charlotte Kelway, Marie Labruyere, Romaric Larcher, Stéphane Legriel, Maxime Leloup, Olivier Lesieur, Isabelle Malissin, Sandie Mazerand, Bruno Mégarbane, Marie-Anne Mélone, Edouard Menoret, Matthieu Metzelard, Nicolas Mongardon, Ly Phack Van Vong, Romain Persichini, Nicolas Pichon, Santiago Picos Gil, Jean-Pierre Quenot, Damien Roux, David Schnell, Florian Sigaud, Clement Suply, Benjamin Sztrymf, Nicolas Terzi, Didier Thevenin, Sebastian Voicu
Bienvenue sur EM-consulte, la référence des professionnels de santé.