Prevalence of Reverse Triggering in Early ARDS: Results From a Multicenter Observational Study

Area of Science:

• Critical Care Medicine
• Respiratory Physiology
• Mechanical Ventilation

Background:

• The prevalence of reverse triggering (RT) during the early phase of Acute Respiratory Distress Syndrome (ARDS) is not well-established.
• Understanding RT is crucial for optimizing mechanical ventilation strategies in ARDS patients.

Purpose of the Study:

• To determine the proportion of ARDS patients experiencing RT in the early mechanical ventilation phase.
• To identify potential predictors of RT.
• To investigate the association between RT and clinical outcomes, including mortality.

Main Methods:

• A prospective, multicenter, observational study was conducted.
• 100 patients meeting the Berlin definition of ARDS within 72 hours of mechanical ventilation and without neuromuscular blockers were enrolled.
• A 30-minute respiratory signal recording was analyzed to count RT events.

Main Results:

• Fifty percent of patients exhibited RT, predominantly without breath stacking.
• RT was associated with lower tidal volumes (Vt) and reduced opiate infusion rates.
• No significant association was found between RT and the duration of mechanical ventilation, but a possible reduction in hospital mortality was observed.

Conclusions:

• RT is common in sedated, non-paralyzed ARDS patients on assist-control ventilation early in the disease course.
• RT may be a marker for lower tidal volumes and opiate requirements.
• RT might be associated with improved survival in ARDS patients.