Reverse Triggering: An Introduction to Diagnosis, Management, and Pharmacologic Implications.

Area of Science:

• Critical Care Medicine
• Respiratory Physiology
• Pharmacology

Background:

• Patient-ventilator asynchrony is a common complication in mechanically ventilated patients.
• Reverse triggering, a specific type of asynchrony, involves unintended patient effort.
• Understanding its physiology and consequences is crucial for patient management.

Purpose of the Study:

• To review the current knowledge on reverse triggering.
• To explore its pharmacotherapeutic implications and drug-device-patient interactions.
• To summarize reported cases, physiology, epidemiology, and management strategies.

Main Methods:

• A comprehensive literature search of the PubMed database was conducted.
• Publications reporting patients with reverse triggering were identified and analyzed.
• Key aspects including physiology, clinical presentation, and management were synthesized.

Main Results:

• Deep sedation is identified as a potential predisposing factor for reverse triggering.
• Initial management strategies may involve decreasing sedation levels or adjusting ventilator settings.
• Limited evidence exists, highlighting the need for further research.

Conclusions:

• Reverse triggering is an underdiagnosed condition with significant patient outcome implications.
• Clinician awareness and further research are essential for effective management.
• Optimizing sedation and ventilator settings are initial steps in addressing this asynchrony.