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Respiratory entrainment related reverse triggering in mechanically ventilated children
Robert G T Blokpoel1, Ruben B R Brandsema2, Alette A Koopman2
1Department of Paediatrics, Division of Paediatric Intensive Care, Beatrix Children's Hospital, University Medical Center Groningen, P.O. Box 30.001 9700 RB, Groningen, CA 62, the Netherlands. r.g.t.blokpoel@umcg.nl.
Respiratory Research
|March 26, 2024
Summary
Reverse triggering in mechanically ventilated children is not a single phenomenon but a spectrum. Understanding its mechanisms, like respiratory entrainment, impacts patient outcomes and ventilation duration.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Physiology
- Mechanical Ventilation
Background:
- The exact causes of reverse triggering (RT) during mechanical ventilation are unclear.
- Respiratory entrainment is often confused with or used interchangeably with RT.
- Characterizing RT and its link to respiratory entrainment in pediatric patients is crucial.
Purpose of the Study:
- To differentiate and characterize reverse triggering (RT) in pediatric patients.
- To investigate the relationship between RT and respiratory entrainment.
- To analyze the impact of RT on mechanical ventilation parameters and patient outcomes.
Main Methods:
- Secondary analysis of existing physiological data from invasively ventilated children (<18 years).
- Utilized ventilator waveforms, esophageal tracings, and diaphragm electromyography.
- Identified and classified breaths as entrained or non-entrained RT.
Main Results:
- Reverse triggering was identified in 50% of recordings (12% entrained, 38% non-entrained).
- Non-entrained RT was associated with increased tidal volume (double triggering) and lower breathing variability.
- Patients with entrainment-related RT experienced shorter mechanical ventilation duration and PICU stay.
Conclusions:
- Reverse triggering represents a spectrum of clinical presentations, not a singular event.
- Different mechanisms of RT have distinct consequences for ventilated children.
- Further research into RT mechanisms can optimize mechanical ventilation strategies.
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