Reverse triggering ? a novel or previously missed phenomenon? - 08/01/26
, Audery Kim 1, *, Nikolay Moroz 1, 3, L. Felipe Damiani 1, 2, 4, Domenico Luca Grieco 1, 2, 5, 6, Thomas Piraino 7, Jan O. Friedrich 1, 2, Alain Mercat 8, Irene Telias 1, 2, Laurent J. Brochard 1, 2
Bienvenue sur EM-consulte, la référence des professionnels de santé.
Article gratuit.
Connectez-vous pour en bénéficier!
Abstract |
Background |
Reverse triggering (RT) was described in 2013 as a form of patient-ventilator asynchrony, where patient’s respiratory effort follows mechanical insufflation. Diagnosis requires esophageal pressure (P es ) or diaphragmatic electrical activity (EA di ), but RT can also be diagnosed using standard ventilator waveforms.
Hypothesis |
We wondered (1) how frequently RT would be present but undetected in the figures from literature, especially before 2013; (2) whether it would be more prevalent in the era of small tidal volumes after 2000.
Methods |
We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials, from 1950 to 2017, with key words related to asynchrony to identify papers with figures including ventilator waveforms expected to display RT if present. Experts labelled waveforms. ‘Definite’ RT was identified when P es or EA di were in the tracing, and ‘possible’ RT when only flow and pressure waveforms were present. Expert assessment was compared to the author’s descriptions of waveforms.
Results |
We found 65 appropriate papers published from 1977 to now, containing 181 ventilator waveforms. 21 cases of ‘possible’ RT and 25 cases of ‘definite’ RT were identified by the experts. 18.8% of waveforms prior to 2013 had evidence of RT. Most cases were published after 2000 (1 before vs. 45 after, p = 0.03). 54% of RT cases were attributed to different phenomena. A few cases of identified RT were already described prior to 2013 using different terminology (earliest in 1997). While RT cases attributed to different phenomena decreased after 2013, 60% of ‘possible’ RT remained missed.
Conclusion |
RT has been present in the literature as early as 1997, but most cases were found after the introduction of low tidal volume ventilation in 2000. Following 2013, the number of undetected cases decreased, but RT are still commonly missed.
Prior Abstract |
Reverse Triggering, A Missed Phenomenon in the Literature. Critical Care Canada Forum 2019 Abstracts. Can J Anesth/J Can Anesth 67 (Suppl 1), 1–162 (2020). https://doi-org.myaccess.library.utoronto.ca/ s12630-019-01552-z .
Le texte complet de cet article est disponible en PDF.Keywords : Lung Protective Ventilation, Mechanical Ventilation, Reverse Triggering, Ventilator Asynchrony
Plan
Vol 14 - N° 1
Article 78- 2024 Retour au numéro
Article précédent
- Efficacy and safety of antibiotics targeting Gram-negative bacteria in nosocomial pneumonia: a systematic review and Bayesian network meta-analysis
- David Luque Paz, Dara Chean, Pierre Tattevin, Damien Luque Paz, Betsega Assefa Bayeh, Achille Kouatchet, Delphine Douillet, Jérémie Riou
- Critical care beyond organ support: the importance of geriatric rehabilitation
- Jeremy M. Jacobs, Ana Rahamim, Michael Beil, Bertrand Guidet, Helene Vallet, Hans Flaatten, Susannah K. Leaver, Dylan de Lange, Wojciech Szczeklik, Christian Jung, Sigal Sviri
Bienvenue sur EM-consulte, la référence des professionnels de santé.