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Mechanical Ventilation II: Invasive Ventilation01:23

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Double-Triggering During Noninvasive Ventilation in a Simulated Lung Model.

Robert D Sheehy1, Brett Duce2,3, Timothy P Edwards2

  • 1Department of Respiratory & Sleep Medicine and Sleep Disorders Centre, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia. robert.sheehy@health.qld.gov.au.

Respiratory Care
|March 19, 2020
PubMed
Summary

Double-triggering in noninvasive ventilation (NIV) occurs more frequently with specific patient and device settings, impacting ventilation delivery. Understanding these factors is key to optimizing NIV therapy.

Keywords:
bench studydouble-triggeringlow lung compliancenoninvasive ventilationpatient-ventilator asynchronysimulated lung model

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Area of Science:

  • Respiratory Mechanics
  • Mechanical Ventilation
  • Pulmonary Physiology

Background:

  • Patient-ventilator asynchrony, specifically double-triggering, is a known issue in noninvasive ventilation (NIV).
  • This study investigates the conditions influencing double-triggering prevalence and its impact on NIV delivery.

Purpose of the Study:

  • To identify patient and device-specific factors contributing to double-triggering in NIV.
  • To assess the consequences of double-triggering on ventilation and work of breathing.

Main Methods:

  • A benchtop lung model simulating various respiratory conditions (compliance, resistance, effort, frequency) was used.
  • Two proprietary NIV devices were tested, manipulating settings like inspiratory and expiratory pressures.
  • Minute ventilation and inspiratory work were measured and correlated with double-triggering frequency.

Main Results:

  • Double-triggering was significantly associated with reduced lung compliance in both devices.
  • Lower breathing frequency, higher respiratory effort, and increased pressure support exacerbated double-triggering in a low-compliance model.
  • Double-triggering correlated with reduced minute ventilation in one device and increased inspiratory work in the other.

Conclusions:

  • Both patient-related factors (lung mechanics, effort) and NIV device characteristics influence double-triggering frequency.
  • Double-triggering has significant implications for the effectiveness of NIV, affecting ventilation and patient work.