Pablo O Rodriguez1, Norberto Tiribelli2, Sebastián Fredes3, Emiliano Gogniat4, Gustavo Plotnikow5, Ignacio Fernandez Ceballos4, Romina Pratto5, Alejandro Raimondi6, María Guaymas2, Santiago Ilutovich7, Eduardo San Román4, Matías Madorno8, Patricio Maskin9, Laurent Brochard10, Mariano Setten11. 1. Intensive Care Unit, Centro de Educación Médica e Investigaciones Clínicas, Ciudad Autónoma de Buenos Aires, Argentina; Pulmonary Medicine School of Medicine, Centro de Educación Médica e Investigaciones Clínicas, Ciudad Autónoma de Buenos Aires, Argentina; Instituto Universitario, Centro de Educación Médica e Investigaciones Clínicas, Ciudad Autónoma de Buenos Aires, Argentina. Electronic address: prodriguez@cemic.edu.ar. 2. Intensive Care Unit, Complejo Médico Churruca Visca, Ciudad Autónoma de Buenos Aires, Argentina. 3. Intensive Care Unit, Complejo Médico Churruca Visca, Ciudad Autónoma de Buenos Aires, Argentina; Intensive Care Unit, Sanatorio de la Trinidad Mitre, Ciudad Autónoma de Buenos Aires, Argentina. 4. Intensive Care Unit, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina. 5. Intensive Care Unit, Sanatorio Anchorena, Ciudad Autónoma de Buenos Aires, Argentina. 6. School of Medicine, University of Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina. 7. Intensive Care Unit, Sanatorio de la Trinidad Mitre, Ciudad Autónoma de Buenos Aires, Argentina. 8. MBMed SA, Ciudad Autónoma de Buenos Aires, Argentina; Instituto Tecnológico de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina. 9. Intensive Care Unit, Centro de Educación Médica e Investigaciones Clínicas, Ciudad Autónoma de Buenos Aires, Argentina; Pulmonary Medicine School of Medicine, Centro de Educación Médica e Investigaciones Clínicas, Ciudad Autónoma de Buenos Aires, Argentina; Instituto Universitario, Centro de Educación Médica e Investigaciones Clínicas, Ciudad Autónoma de Buenos Aires, Argentina. 10. Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada. 11. Intensive Care Unit, Centro de Educación Médica e Investigaciones Clínicas, Ciudad Autónoma de Buenos Aires, Argentina; Universidad del Salvador Medical School, Ciudad Autónoma de Buenos Aires, Argentina.
Abstract
BACKGROUND: The prevalence of reverse triggering (RT) in the early phase of ARDS is unknown. RESEARCH QUESTION: During early ARDS, what is the proportion of patients affected by RT, what are its potential predictors, and what is its association with clinical outcomes? STUDY DESIGN AND METHODS: This was prospective, multicenter, and observational study. Patients who met the Berlin definition of ARDS with less than 72 h of mechanical ventilation and had not been paralyzed with neuromuscular blockers were screened. A 30-min recording of respiratory signals was obtained from the patients as soon as they were enrolled, and the number of breaths with RT were counted. RESULTS: One hundred patients were included. ARDS was mild to moderate in 92% of them. The recordings were obtained after a median of 1 day (interquartile range, 1-2 days) of ventilation. Fifty patients had RT, and most of these events (97%) were not associated with breath stacking. Detecting RT was associated with lower tidal volume (Vt) and less opiate infusion. The presence of RT was not associated with time to discontinuation of mechanical ventilation (subdistribution hazard ratio, 1.03; 95% CI, 0.6-1.77), but it possibly was associated with a reduced hospital mortality (hazard ratio, 0.65; 95% CI, 0.57-0.73). INTERPRETATION: Fifty percent of patients receiving assist-control ventilation for mild or moderate ARDS, sedated and nonparalyzed, demonstrate RT without breath stacking on the first day of mechanical ventilation. RT may be associated with low VTS and opiate doses. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT02732041; URL: www.clinicaltrials.gov.
BACKGROUND: The prevalence of reverse triggering (RT) in the early phase of ARDS is unknown. RESEARCH QUESTION: During early ARDS, what is the proportion of patients affected by RT, what are its potential predictors, and what is its association with clinical outcomes? STUDY DESIGN AND METHODS: This was prospective, multicenter, and observational study. Patients who met the Berlin definition of ARDS with less than 72 h of mechanical ventilation and had not been paralyzed with neuromuscular blockers were screened. A 30-min recording of respiratory signals was obtained from the patients as soon as they were enrolled, and the number of breaths with RT were counted. RESULTS: One hundred patients were included. ARDS was mild to moderate in 92% of them. The recordings were obtained after a median of 1 day (interquartile range, 1-2 days) of ventilation. Fifty patients had RT, and most of these events (97%) were not associated with breath stacking. Detecting RT was associated with lower tidal volume (Vt) and less opiate infusion. The presence of RT was not associated with time to discontinuation of mechanical ventilation (subdistribution hazard ratio, 1.03; 95% CI, 0.6-1.77), but it possibly was associated with a reduced hospital mortality (hazard ratio, 0.65; 95% CI, 0.57-0.73). INTERPRETATION: Fifty percent of patients receiving assist-control ventilation for mild or moderate ARDS, sedated and nonparalyzed, demonstrate RT without breath stacking on the first day of mechanical ventilation. RT may be associated with low VTS and opiate doses. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT02732041; URL: www.clinicaltrials.gov.
Authors: Brian Murray; Andrea Sikora; Jason R Mock; Thomas Devlin; Kelli Keats; Rebecca Powell; Thomas Bice Journal: Front Pharmacol Date: 2022-06-22 Impact factor: 5.988
Authors: Luis Patricio Maskin; Ignacio Bonelli; Gabriel Leonardo Olarte; Fernando Palizas; Agostina E Velo; María Fernanda Lurbet; Pablo Lovazzano; Sophia Kotsias; Shiry Attie; Ignacio Lopez Saubidet; Natalio D Baredes; Mariano Setten; Pablo Oscar Rodriguez Journal: J Intensive Care Med Date: 2021-12-13 Impact factor: 3.510