Mechanical Ventilation-Induced Reverse-Triggered Breaths A Frequently Unrecognized Form of Neuromechanical Coupling
Por:
Akoumianaki, E, Lyazidi, A, Rey, N, Matamis, D, Perez-Martinez, N, Giraud, R, Mancebo, J, Brochard, L, Richard, JCM
Publicada:
1 abr 2013
Resumen:
Background: Diaphragmatic muscle contractions triggered by ventilator insufflations constitute a form of patient-ventilator interaction referred to as "entrainment," which is usually unrecognized in critically ill patients. Our objective was to review tracings, which also included muscular activity, obtained in sedated patients who were mechanically ventilated to describe the entrainment events and their characteristics. The term "reverse triggering" was adopted to describe the ventilator-triggered muscular efforts.
Methods: Over a 3-month period, recordings containing flow, airway pressure, and esophageal pressure or electrical activity of the diaphragm were reviewed. Recordings were obtained from a. series of consecutive heavily sedated patients ventilated with an assist-control Mode of ventilation for ARDS. The duration of entrainment, the. entrainment ratio, and the phase difference elapsing between the commencement of the ventilator and neural breaths were evaluated.
Results: The tracings of eight consecutive patients with ARDS were reviewed; they all showed different forms of entrainment. Reverse triggering occurred over a portion varying from 12% to 100% of the total recording period. Seven patients had a 1:1 mechanical insufflation to diaphragmatic contractions ratio; this coexisted with a 1:2 ratio in one patient and 1:2 and 1:3 ratios in another. One patient exhibited only a 1:2 ratio. The frequency of reverse-triggered breaths had a mean coefficient of variability of <5%, very close to the variability of mechanical breaths.
Conclusions: To our knowledge, this is the first time that the presence of respiratory entrainment in sedated, critically ill adult patients who are mechanically ventilated has been documented. The "reverse-triggered" breaths illustrate a new form of neuromechanical coupling with potentially important clinical consequences. CHEST 2013; 143(4):927-938
Filiaciones:
Akoumianaki, E:
Univ Geneva, Intens Care Unit Div, Geneva, Switzerland
Lyazidi, A:
Univ Geneva, Intens Care Unit Div, Geneva, Switzerland
Univ Geneva, Anesthesiol Pharmacol & Intens Care Dept, Geneva, Switzerland
Univ Geneva, Sch Med, CH-1211 Geneva, Switzerland
Rey, N:
Univ Geneva, Intens Care Unit Div, Geneva, Switzerland
Matamis, D:
Univ Geneva, Intens Care Unit Div, Geneva, Switzerland
Perez-Martinez, N:
Univ Geneva, Intens Care Unit Div, Geneva, Switzerland
Giraud, R:
Univ Geneva, Intens Care Unit Div, Geneva, Switzerland
Mancebo, J:
Hosp Santa Creu & Sant Pau, Serv Med Intens, Barcelona, Spain
Brochard, L:
Univ Geneva, Intens Care Unit Div, Geneva, Switzerland
Univ Geneva, Anesthesiol Pharmacol & Intens Care Dept, Geneva, Switzerland
Univ Geneva, Sch Med, CH-1211 Geneva, Switzerland
Richard, JCM:
Univ Geneva, Intens Care Unit Div, Geneva, Switzerland
Univ Geneva, Anesthesiol Pharmacol & Intens Care Dept, Geneva, Switzerland
Univ Geneva, Sch Med, CH-1211 Geneva, Switzerland
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