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Published on: November 19, 2015
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.
Insights
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.
Background:
The underlying pathophysiological pathways how reverse triggering is being caused are not fully understood. Respiratory entrainment may be one of these mechanisms, but both terms are used interchangeably. We sought to characterize reverse triggering and the relationship with respiratory entrainment among mechanically ventilated children with and without acute lung injury.
Methods:
We performed a secondary phyiology analysis of two previously published data sets of invasively mechanically ventilated children < 18 years with and without lung injury mechanically ventilated in a continuous or intermittent mandatory ventilation mode. Ventilator waveforms, electrical activity of the diaphragm measured with surface electromyography and oesophageal tracings were analyzed for entrained and non-entrained reverse triggered breaths.
Results:
In total 102 measurements (3110 min) from 67 patients (median age 4.9 [1.8 ; 19,1] months) were analyzed. Entrained RT was identified in 12 (12%) and non-entrained RT in 39 (38%) recordings. Breathing variability for entrained RT breaths was lower compared to non-entrained RT breaths. We did not observe breath stacking during entrained RT. Double triggering often occurred during non-entrained RT and led to an increased tidal volume. Patients with respiratory entrainment related RT had a shorter duration of MV and length of PICU stay.
Conclusions:
Reverse triggering is not one entity but a clinical spectrum with different mechanisms and consequences.
Trial Registration:
Not applicable.
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