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Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex
Published on: July 4, 2018
A noninvasive method to identify ineffective triggering in patients with noninvasive pressure support ventilation
Antoine Cuvelier1, Linda Achour, Herinaina Rabarimanantsoa
1Pulmonary and Intensive Care Department, Rouen University Hospital & UPRES EA 3830 (IFR MP23), Institute for Biomedical Research, Rouen, France. antoine.cuvelier@chu-rouen.fr
Respiration; International Review of Thoracic Diseases
|December 4, 2009
Summary
A new mathematical analysis of breathing patterns can reliably detect ineffective triggering efforts during noninvasive ventilation without invasive measurements. This method improves the assessment of patient-ventilator interactions and their impact on breathing.
Area of Science:
- Biomedical Engineering
- Respiratory Medicine
- Critical Care
Background:
- Ineffective inspiratory triggering is a common issue in mechanical ventilation, leading to poor patient-ventilator synchrony.
- Current methods for identifying these efforts often require invasive esophageal catheterization.
Purpose of the Study:
- To develop a noninvasive mathematical analysis of ventilatory tracings.
- To identify ineffective triggering efforts and their consequences without esophageal pressure monitoring.
Main Methods:
- Analysis of 2,183 ventilatory cycles from 44 pressure support tracings in 14 children with cystic fibrosis.
- Development of a dedicated algorithm to analyze airway pressure and flow time series.
- Validation of the algorithm's performance against esophageal pressure measurements.
Main Results:
- A mathematical treatment of flow time series enabled the identification of distinct trajectories for triggered and ineffective efforts.
- The algorithm achieved 100% accuracy in identifying triggered cycles and 94.6% in identifying ineffective triggering efforts.
- Ineffective triggering was linked to reduced minute ventilation, inspiratory flow, and increased inspiratory effort.
Conclusions:
- Noninvasive analysis of flow and airway pressure reliably detects ineffective triggering during noninvasive pressure support ventilation.
- This algorithm offers a valuable, noninvasive tool for assessing patient-ventilator interactions during long-term ventilation.
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