Reverse Trigger in Ventilated Non-ARDS Patients: A Phenomenon Can Not Be Ignored!

Area of Science:

• Critical Care Medicine
• Respiratory Physiology
• Mechanical Ventilation

Background:

• The role of reverse trigger (RT) in ventilated patients without acute respiratory distress syndrome (ARDS) was previously unknown.
• Understanding RT in this population is crucial for optimizing mechanical ventilation strategies.

Purpose of the Study:

• To evaluate the incidence, characteristics, and physiological consequences of reverse trigger (RT) in patients on mechanical ventilation without ARDS.
• To compare RT patterns in non-ARDS patients to those observed in ARDS patients.

Main Methods:

• A retrospective study included six ventilated non-ARDS patients.
• Esophageal balloon catheters were used to measure respiratory mechanics.
• Data analysis focused on RT occurrence, entrainment patterns, phase differences, phenotypes, and clinical correlations.

Main Results:

• Reverse trigger (RT) was detected in 66.7% of the studied patients, occurring between 19% and 88.6% of recording time.
• Mid-cycle RT was the most common phenotype, followed by late RT and RT with breath stacking.
• RT increased esophageal pressure (Peso) by an average of 17.27 cmH2O, significantly increasing lung pressure (PL).

Conclusions:

• Reverse trigger (RT) is observable in ventilated non-ARDS patients.
• RT characteristics and phenotypes in non-ARDS patients largely resemble those in ARDS patients.
• RT can significantly alter lung stress and delivered tidal volumes in ventilated non-ARDS patients.