Document Detail


A noninvasive method to identify ineffective triggering in patients with noninvasive pressure support ventilation.
MedLine Citation:
PMID:  19955701     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Ineffective inspiratory triggering efforts are a major cause of poor patient-ventilator interactions during mechanical ventilation, but their routine identification requires the insertion of an esophageal catheter.
OBJECTIVES: We developed a mathematical analysis of ventilatory tracings recorded under noninvasive pressure ventilation in order to identify ineffective triggering efforts and their consequences without recording esophageal pressure.
METHODS: We assessed 2,183 cycles from 44 pressure support tracings in 14 children with cystic fibrosis treated by noninvasive home ventilation. Airway pressure, flow and esophageal pressure time series were visually analyzed and manually counted. Airway pressure versus time and flow versus time were then analyzed using a dedicated algorithm written by us. Esophageal pressure was only used for validation.
RESULTS: A mathematical treatment of flow time series allowed us to draw phase portraits that had specific periodic trajectories for triggered ventilatory cycles and ineffective triggering efforts. From flow and pressure tracings, our algorithm correctly identified 100% of triggered cycles and 53/56 (94.6%) of ineffective triggering efforts. Ineffective triggering was associated with a significant reduction in minute ventilation, inspiratory flows and a significant increase in inspiratory efforts.
CONCLUSIONS: A noninvasive analysis of flow and airway pressure can reliably identify ineffective triggering efforts during noninvasive pressure support ventilation. This approach may be a valuable tool for evaluating patient-ventilator interactions and their consequences during long-term recordings.
Authors:
Antoine Cuvelier; Linda Achour; Herinaina Rabarimanantsoa; Christophe Letellier; Jean-François Muir; Brigitte Fauroux
Publication Detail:
Type:  Journal Article; Validation Studies     Date:  2009-12-02
Journal Detail:
Title:  Respiration; international review of thoracic diseases     Volume:  80     ISSN:  1423-0356     ISO Abbreviation:  Respiration     Publication Date:  2010  
Date Detail:
Created Date:  2010-08-11     Completed Date:  2010-12-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0137356     Medline TA:  Respiration     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  198-206     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2009 S. Karger AG, Basel.
Affiliation:
Pulmonary and Intensive Care Department, Rouen University Hospital & UPRES EA 3830 (IFR MP23), Institute for Biomedical Research, Rouen, France. antoine.cuvelier@chu-rouen.fr
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Algorithms
Humans
Male
Positive-Pressure Respiration / standards*
Respiration*
Retrospective Studies

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