Reverse triggering ? a novel or previously missed phenomenon?

IF 5.7 1区医学 Q1 CRITICAL CARE MEDICINE

Annals of Intensive Care Pub Date : 2024-05-22 DOI:10.1186/s13613-024-01303-4

Robert Jackson, Audery Kim, Nikolay Moroz, L Felipe Damiani, Domenico Luca Grieco, Thomas Piraino, Jan O Friedrich, Alain Mercat, Irene Telias, Laurent J Brochard

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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 (P_es) or diaphragmatic electrical activity (EA_di), 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 P_es or EA_di 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. 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 .

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反向触发？一种新的或以前被忽视的现象？

背景：反向触发（RT）于 2013 年被描述为患者与呼吸机不同步的一种形式，即患者的呼吸努力跟随机械充气。诊断需要食管压力（Pes）或膈肌电活动（EAdi），但 RT 也可通过标准呼吸机波形进行诊断：我们想知道：（1）在文献数据中，尤其是在 2013 年之前，RT 存在但未被发现的频率有多高；（2）在 2000 年之后的小潮气量时代，RT 是否会更加普遍：我们用与异步相关的关键词检索了1950年至2017年的PubMed、EMBASE和Cochrane对照试验中央登记册，以识别包含呼吸机波形（如果存在，预计会显示RT）的论文。专家对波形进行了标注。当描记中出现 Pes 或 EAdi 时，"确定 "RT 即被识别；当仅出现流量和压力波形时，"可能 "RT 即被识别。将专家评估与作者对波形的描述进行比较：我们找到了从 1977 年至今发表的 65 篇相关论文，其中包含 181 个呼吸机波形。专家确定了 21 例 "可能的 "RT 和 25 例 "确定的 "RT。2013年之前的波形中有18.8%存在RT证据。大多数病例发表于 2000 年之后（2000 年前 1 例，2000 年后 45 例，P = 0.03）。54%的RT病例归因于不同的现象。少数已确认的RT病例在2013年之前已经使用不同的术语进行了描述（最早的病例出现在1997年）。虽然2013年后归因于不同现象的RT病例有所减少，但仍有60%的 "可能 "RT被遗漏：RT早在1997年就出现在文献中，但大多数病例是在2000年引入低潮气量通气后发现的。2013 年之后，未发现的病例数量有所减少，但 RT 仍经常被漏诊。反向触发，文献中被遗漏的现象。2019年加拿大重症监护论坛摘要。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 。

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来源期刊

Annals of Intensive Care CRITICAL CARE MEDICINE-

CiteScore

14.20

自引率

3.70%

发文量

107

审稿时长

13 weeks

期刊介绍： Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.