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Automated detection and quantification of reverse triggering effort under mechanical ventilation.
Tài Pham1,2,3, Jaume Montanya4, Irene Telias5,6,7,8
1Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada. tai.pham@aphp.fr.
Critical Care (London, England)
|February 16, 2021
Summary
Reverse triggering (RT) is a harmful breathing dyssynchrony. An automated tool accurately detects RT using airway pressure and flow, revealing significant patient effort during these events.
Area of Science:
- Critical Care Medicine
- Respiratory Physiology
- Medical Technology
Background:
- Reverse triggering (RT) is a potentially harmful respiratory dyssynchrony.
- Detection of RT is challenging, and the magnitude of patient effort is unknown.
- RT involves respiratory muscle contraction following mechanical insufflation.
Purpose of the Study:
- To validate supervised methods for automatic RT detection using airway pressure and flow.
- To quantify the magnitude of respiratory effort generated during RT.
Main Methods:
- Developed algorithms for RT detection using airway pressure (Paw) and flow waveforms.
- Expert assessment of automatic detection accuracy against visual evaluation (including esophageal pressure).
- Measured muscular pressure (Pmus) during RT, triggered breaths, and ineffective efforts.
Main Results:
- Automatic detection achieved 95.5% accuracy (83.1% sensitivity, 99.4% specificity).
- RT was present in 24% of breaths across 20 hypoxemic patients.
- Median Pmus during RT was 8.7 cmH2O, with a range of 1.3–36.8 cmH2O.
Conclusions:
- An automated tool accurately diagnoses RT using airway pressure and flow.
- RT generates significant, variable muscular effort (median 9 cmH2O).
- Understanding RT effort is crucial for patient management in critical care settings.
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