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Reverse Trigger Phenotypes in Acute Respiratory Distress Syndrome.
Baedorf Kassis, Elias; Su, Henry K; Graham, Alexander R; Novack, Victor; Loring, Stephen H; Talmor, Daniel S.
Afiliação
  • Baedorf Kassis E; Division of Pulmonary and Critical Care.
  • Su HK; Harvard Medical School, Boston, Massachusetts; and.
  • Graham AR; Department of Anesthesia, Critical Care and Pain Medicine, and.
  • Novack V; Harvard Medical School, Boston, Massachusetts; and.
  • Loring SH; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
  • Talmor DS; Harvard Medical School, Boston, Massachusetts; and.
Am J Respir Crit Care Med ; 203(1): 67-77, 2021 01 01.
Article em En | MEDLINE | ID: mdl-32809842
Rationale: Reverse triggering is an underexplored form of dyssynchrony with important clinical implications in patients with acute respiratory distress syndrome.Objectives: This retrospective study identified reverse trigger phenotypes and characterized their impacts on Vt and transpulmonary pressure.Methods: Fifty-five patients with acute respiratory distress syndrome on pressure-regulated ventilator modes were included. Four phenotypes of reverse triggering with and without breath stacking and their impact on lung inflation and deflation were investigated.Measurements and Main Results: Inflation volumes, respiratory muscle pressure generation, and transpulmonary pressures were determined and phenotypes differentiated using Campbell diagrams of respiratory activity. Reverse triggering was detected in 25 patients, 15 with associated breath stacking, and 13 with stable reverse triggering consistent with respiratory entrainment. Phenotypes were associated with variable levels of inspiratory effort (mean 4-10 cm H2O per phenotype). Early reverse triggering with early expiratory relaxation increased Vts (88 [64-113] ml) and inspiratory transpulmonary pressures (3 [2-3] cm H2O) compared with passive breaths. Early reverse triggering with delayed expiratory relaxation increased Vts (128 [86-170] ml) and increased inspiratory and mean-expiratory transpulmonary pressure (7 [5-9] cm H2O and 5 [4-6] cm H2O). Mid-cycle reverse triggering (initiation during inflation and maximal effort during deflation) increased Vt (51 [38-64] ml), increased inspiratory and mean-expiratory transpulmonary pressure (3 [2-4] cm H2O and 3 [2-3] cm H2O), and caused incomplete exhalation. Late reverse triggering (occurring exclusively during exhalation) increased mean expiratory transpulmonary pressure (2 [1-2] cm H2O) and caused incomplete exhalation. Breath stacking resulted in large delivered volumes (176 [155-197] ml).Conclusions: Reverse triggering causes variable physiological effects, depending on the phenotype. Differentiation of phenotype effects may be important to understand the clinical impacts of these events.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Fenótipo / Síndrome do Desconforto Respiratório / Mecânica Respiratória / Volume de Ventilação Pulmonar / Respiração com Pressão Positiva Tipo de estudo: Observational_studies / Prognostic_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Fenótipo / Síndrome do Desconforto Respiratório / Mecânica Respiratória / Volume de Ventilação Pulmonar / Respiração com Pressão Positiva Tipo de estudo: Observational_studies / Prognostic_studies Limite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Ano de publicação: 2021 Tipo de documento: Article