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Additional work of breathing from trigger errors in mechanically ventilated children
Robert G T Blokpoel1, Alette A Koopman2, Jefta van Dijk2
1Department of Paediatrics, Division of Paediatric Intensive Care, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Internal Postal Code CA 62, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands. r.g.t.blokpoel@umcg.nl.
Insights
Trigger errors in pediatric mechanical ventilation significantly increase work-of-breathing, potentially up to 40%. Reducing these errors is key for better patient outcomes in pediatric intensive care.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Physiology
- Mechanical Ventilation
Background:
- Patient-ventilator asynchrony is linked to poor outcomes in ventilated patients.
- Trigger errors may cause excessive pleural pressure swings, increasing work-of-breathing and lung injury.
- The direct impact of patient-ventilator asynchrony on clinical outcomes requires further investigation.
Purpose of the Study:
- To quantify the additional work-of-breathing and pleural pressure swings resulting from trigger errors in mechanically ventilated children.
- To investigate the relationship between trigger errors and patient-ventilator interaction.
Main Methods:
- Prospective observational study in a tertiary pediatric intensive care unit.
- Recorded ventilator and esophageal pressure data in children ventilated for over 24 hours.
- Calculated pressure-time product for work-of-breathing and measured esophageal pressure swings during trigger errors.
Main Results:
- Identified 959 trigger errors across 28 pediatric patients.
- Trigger errors caused significant, variable increases in work-of-breathing.
- Higher spontaneous breathing rates correlated with fewer trigger errors.
Conclusions:
- Trigger errors can contribute substantially (30-40%) to the total work-of-breathing in ventilated children.
- Spontaneously breathing patients with higher pressure generation experienced fewer trigger errors.
Background:
Patient-ventilator asynchrony is associated with increased morbidity and mortality. A direct causative relationship between Patient-ventilator asynchrony and adverse clinical outcome have yet to be demonstrated. It is hypothesized that during trigger errors excessive pleural pressure swings are generated, contributing to increased work-of-breathing and self-inflicted lung injury. The objective of this study was to determine the additional work-of-breathing and pleural pressure swings caused by trigger errors in mechanically ventilated children.
Methods:
Prospective observational study in a tertiary paediatric intensive care unit in an university hospital. Patients ventilated > 24 h and < 18 years old were studied. Patients underwent a 5-min recording of the ventilator flow-time, pressure-time and oesophageal pressure-time scalar. Pressure-time-product calculations were made as a proxy for work-of-breathing. Oesophageal pressure swings, as a surrogate for pleural pressure swings, during trigger errors were determined.
Results:
Nine-hundred-and-fifty-nine trigger errors in 28 patients were identified. The additional work-of-breathing caused by trigger errors showed great variability among patients. The more asynchronous breaths were present the higher the work-of-breathing of these breaths. A higher spontaneous breath rate led to a lower amount of trigger errors. Patient-ventilator asynchrony was not associated with prolonged duration of mechanical ventilation or paediatric intensive care stay.
Conclusions:
The additional work-of-breathing caused by trigger errors in ventilated children can take up to 30-40% of the total work-of-breathing. Trigger errors were less common in patients breathing spontaneously and those able to generate higher pressure-time-product and pressure swings.
Trial Registration:
Not applicable.
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