Ineffective triggering predicts increased duration of mechanical ventilation.
Crit Care Med
; 37(10): 2740-5, 2009 Oct.
Article
em En
| MEDLINE
| ID: mdl-19886000
ABSTRACT
OBJECTIVES:
To determine whether high rates of ineffective triggering within the first 24 hrs of mechanical ventilation (MV) are associated with longer MV duration and shorter ventilator-free survival (VFS).DESIGN:
Prospective cohort study.SETTING:
Medical intensive care unit (ICU) at an academic medical center. PATIENTS Sixty patients requiring invasive MV.INTERVENTIONS:
None. MEASUREMENTS Patients had pressure-time and flow-time waveforms recorded for 10 mins within the first 24 hrs of MV initiation. Ineffective triggering index (ITI) was calculated by dividing the number of ineffectively triggered breaths by the total number of breaths (triggered and ineffectively triggered). A priori, patients were classified into ITI >or=10% or ITI <10%. Patient demographics, MV reason, codiagnosis of chronic obstructive pulmonary disease (COPD), sedation levels, and ventilator parameters were recorded. MEASUREMENTS AND MAINRESULTS:
Sixteen of 60 patients had ITI >or=10%. The two groups had similar characteristics, including COPD frequency and ventilation parameters, except that patients with ITI >or=10% were more likely to have pressured triggered breaths (56% vs. 16%, p = .003) and had a higher intrinsic respiratory rate (22 breaths/min vs. 18, p = .03), but the set ventilator rate was the same in both groups (9 breaths/min vs. 9, p = .78). Multivariable analyses adjusting for pressure triggering also demonstrated that ITI >or=10% was an independent predictor of longer MV duration (10 days vs. 4, p = .0004) and shorter VFS (14 days vs. 21, p = .03). Patients with ITI >or=10% had a longer ICU length of stay (8 days vs. 4, p = .01) and hospital length of stay (21 days vs. 8, p = .03). Mortality was the same in the two groups, but patients with ITI >or=10% were less likely to be discharged home (44% vs. 73%, p = .04).CONCLUSIONS:
Ineffective triggering is a common problem early in the course of MV and is associated with increased morbidity, including longer MV duration, shorter VFS, longer length of stay, and lower likelihood of home discharge.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Ventiladores Mecânicos
/
Respiração por Pressão Positiva Intrínseca
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Análise de Falha de Equipamento
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Doença Pulmonar Obstrutiva Crônica
/
Unidades de Terapia Intensiva
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
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Female
/
Humans
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Male
/
Middle aged
Idioma:
En
Revista:
Crit Care Med
Ano de publicação:
2009
Tipo de documento:
Article
País de afiliação:
Estados Unidos