Reverse Triggered Breath during Pressure Support Ventilation and Neurally Adjusted Ventilatory Assist at Increasing Propofol Infusion.
neurally adjusted ventilatory assist
patient-ventilator asynchrony
pressure support ventilation
propofol
reverse triggered breath
sedation
Journal
Journal of clinical medicine
ISSN: 2077-0383
Titre abrégé: J Clin Med
Pays: Switzerland
ID NLM: 101606588
Informations de publication
Date de publication:
24 Jul 2023
24 Jul 2023
Historique:
received:
29
06
2023
revised:
18
07
2023
accepted:
22
07
2023
medline:
29
7
2023
pubmed:
29
7
2023
entrez:
29
7
2023
Statut:
epublish
Résumé
Reverse triggered breath (RTB) has been extensively described during assisted-controlled modes of ventilation. We aimed to assess whether RTB occurs during Pressure Support Ventilation (PSV) and Neurally Adjusted Ventilatory Assist (NAVA) at varying depths of propofol sedation. This is a retrospective analysis of a prospective crossover randomized controlled trial conducted in an Intensive Care Unit (ICU) of a university hospital. Fourteen intubated patients for acute respiratory failure received six trials of 25 minutes randomly applying PSV and NAVA at three different propofol infusions: awake, light, and deep sedation. We assessed the occurrence of RTBs at each protocol step. The incidence level of RTBs was determined through the RTB index, which was calculated by dividing RTBs by the total number of breaths triggered and not triggered. RTBs occurred during both PSV and NAVA. The RTB index was greater during PSV than during NAVA at mild (1.5 [0.0; 5.3]% vs. 0.6 [0.0; 1.1]%) and deep (5.9 [0.7; 9.0]% vs. 1.7 [0.9; 3.5]%) sedation. RTB occurs in patients undergoing assisted mechanical ventilation. The level of propofol sedation and the mode of ventilation may influence the incidence of RTBs.
Sections du résumé
BACKGROUND
BACKGROUND
Reverse triggered breath (RTB) has been extensively described during assisted-controlled modes of ventilation. We aimed to assess whether RTB occurs during Pressure Support Ventilation (PSV) and Neurally Adjusted Ventilatory Assist (NAVA) at varying depths of propofol sedation.
METHODS
METHODS
This is a retrospective analysis of a prospective crossover randomized controlled trial conducted in an Intensive Care Unit (ICU) of a university hospital. Fourteen intubated patients for acute respiratory failure received six trials of 25 minutes randomly applying PSV and NAVA at three different propofol infusions: awake, light, and deep sedation. We assessed the occurrence of RTBs at each protocol step. The incidence level of RTBs was determined through the RTB index, which was calculated by dividing RTBs by the total number of breaths triggered and not triggered.
RESULTS
RESULTS
RTBs occurred during both PSV and NAVA. The RTB index was greater during PSV than during NAVA at mild (1.5 [0.0; 5.3]% vs. 0.6 [0.0; 1.1]%) and deep (5.9 [0.7; 9.0]% vs. 1.7 [0.9; 3.5]%) sedation.
CONCLUSIONS
CONCLUSIONS
RTB occurs in patients undergoing assisted mechanical ventilation. The level of propofol sedation and the mode of ventilation may influence the incidence of RTBs.
Identifiants
pubmed: 37510970
pii: jcm12144857
doi: 10.3390/jcm12144857
pmc: PMC10381884
pii:
doi:
Types de publication
Journal Article
Langues
eng
Références
Intensive Care Med. 2016 Sep;42(9):1427-36
pubmed: 27342819
Anesthesiology. 2021 May 1;134(5):760-769
pubmed: 33662121
Minerva Anestesiol. 2019 Jun;85(6):676-688
pubmed: 30762325
Anesthesiology. 2014 Nov;121(5):1028-36
pubmed: 25208082
Crit Care Med. 2011 Nov;39(11):2452-7
pubmed: 21705886
Intensive Care Med. 2009 May;35(5):840-6
pubmed: 19183949
J Clin Monit Comput. 2020 Dec;34(6):1239-1246
pubmed: 31853811
Minerva Anestesiol. 2013 Apr;79(4):434-44
pubmed: 23254162
Expert Rev Respir Med. 2018 Jul;12(7):557-567
pubmed: 29792537
Am J Respir Crit Care Med. 2020 Apr 1;201(7):e24-e25
pubmed: 31825659
Arch Bronconeumol. 2009 Feb;45(2):68-74
pubmed: 19232267
Crit Care Med. 2014 Jan;42(1):74-82
pubmed: 23982026
Respir Physiol Neurobiol. 2017 Oct;244:10-16
pubmed: 28673877
Curr Opin Crit Care. 2015 Feb;21(1):58-64
pubmed: 25486574
Crit Care Med. 2000 Feb;28(2):402-7
pubmed: 10708174
Crit Care. 2016 Jul 02;20(1):206
pubmed: 27368279
ERJ Open Res. 2017 Oct 04;3(4):
pubmed: 29204431
Crit Care Clin. 2018 Jul;34(3):325-341
pubmed: 29907268
Anesthesiology. 2023 Mar 1;138(3):317-334
pubmed: 36749422
Chest. 2013 Apr;143(4):927-938
pubmed: 23187649
Am J Respir Crit Care Med. 1999 Sep;160(3):950-60
pubmed: 10471624