Back to Search Start Over

Reverse triggering ? a novel or previously missed phenomenon?

Authors :
Robert Jackson
Audery Kim
Nikolay Moroz
L. Felipe Damiani
Domenico Luca Grieco
Thomas Piraino
Jan O. Friedrich
Alain Mercat
Irene Telias
Laurent J. Brochard
Source :
Annals of Intensive Care, Vol 14, Iss 1, Pp 1-13 (2024)
Publication Year :
2024
Publisher :
SpringerOpen, 2024.

Abstract

Abstract Background Reverse triggering (RT) was described in 2013 as a form of patient-ventilator asynchrony, where patient’s respiratory effort follows mechanical insufflation. Diagnosis requires esophageal pressure (Pes) or diaphragmatic electrical activity (EAdi), but RT can also be diagnosed using standard ventilator waveforms. Hypothesis We wondered (1) how frequently RT would be present but undetected in the figures from literature, especially before 2013; (2) whether it would be more prevalent in the era of small tidal volumes after 2000. Methods We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials, from 1950 to 2017, with key words related to asynchrony to identify papers with figures including ventilator waveforms expected to display RT if present. Experts labelled waveforms. ‘Definite’ RT was identified when Pes or EAdi were in the tracing, and ‘possible’ RT when only flow and pressure waveforms were present. Expert assessment was compared to the author’s descriptions of waveforms. Results We found 65 appropriate papers published from 1977 to now, containing 181 ventilator waveforms. 21 cases of ‘possible’ RT and 25 cases of ‘definite’ RT were identified by the experts. 18.8% of waveforms prior to 2013 had evidence of RT. Most cases were published after 2000 (1 before vs. 45 after, p = 0.03). 54% of RT cases were attributed to different phenomena. A few cases of identified RT were already described prior to 2013 using different terminology (earliest in 1997). While RT cases attributed to different phenomena decreased after 2013, 60% of ‘possible’ RT remained missed. Conclusion RT has been present in the literature as early as 1997, but most cases were found after the introduction of low tidal volume ventilation in 2000. Following 2013, the number of undetected cases decreased, but RT are still commonly missed. Prior Abstract Reverse Triggering, A Missed Phenomenon in the Literature. Critical Care Canada Forum 2019 Abstracts. Can J Anesth/J Can Anesth 67 (Suppl 1), 1–162 (2020). https://doi-org.myaccess.library.utoronto.ca/ https://doi.org/10.1007/s12630-019-01552-z .

Details

Language :
English
ISSN :
21105820
Volume :
14
Issue :
1
Database :
Directory of Open Access Journals
Journal :
Annals of Intensive Care
Publication Type :
Academic Journal
Accession number :
edsdoj.9c03bbcfc4a4fbe9e0f22a0856c2a6a
Document Type :
article
Full Text :
https://doi.org/10.1186/s13613-024-01303-4