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. 2022 Jul 1;50(7):e619-e629.
doi: 10.1097/CCM.0000000000005471. Epub 2022 Feb 7.

The Effect of Clusters of Double Triggering and Ineffective Efforts in Critically Ill Patients

Rudys Magrans  1 , Francini Ferreira  1 , Leonardo Sarlabous  2   3 , Josefina López-Aguilar  2 , Gemma Gomà  2 , Sol Fernandez-Gonzalo  2   4   5 , Guillem Navarra-Ventura  2   3 , Rafael Fernández  6 , Jaume Montanyà  1 , Robert Kacmarek  7 , Montserrat Rué  8   9 , Carles Forné  8   10 , Lluís Blanch  2   3 , Candelaria de Haro  2 , José Aquino-Esperanza  2   3   11 ; ASYNICU group
Collaborators, Affiliations

The Effect of Clusters of Double Triggering and Ineffective Efforts in Critically Ill Patients

Rudys Magrans et al. Crit Care Med. .

Abstract

Objectives: To characterize clusters of double triggering and ineffective inspiratory efforts throughout mechanical ventilation and investigate their associations with mortality and duration of ICU stay and mechanical ventilation.

Design: Registry-based, real-world study.

Background: Asynchronies during invasive mechanical ventilation can occur as isolated events or in clusters and might be related to clinical outcomes.

Subjects: Adults requiring mechanical ventilation greater than 24 hours for whom greater than or equal to 70% of ventilator waveforms were available.

Interventions: We identified clusters of double triggering and ineffective inspiratory efforts and determined their power and duration. We used Fine-Gray's competing risk model to analyze their effects on mortality and generalized linear models to analyze their effects on duration of mechanical ventilation and ICU stay.

Measurements and main results: We analyzed 58,625,796 breaths from 180 patients. All patients had clusters (mean/d, 8.2 [5.4-10.6]; mean power, 54.5 [29.6-111.4]; mean duration, 20.3 min [12.2-34.9 min]). Clusters were less frequent during the first 48 hours (5.5 [2.5-10] vs 7.6 [4.4-9.9] in the remaining period [p = 0.027]). Total number of clusters/d was positively associated with the probability of being discharged alive considering the total period of mechanical ventilation (p = 0.001). Power and duration were similar in the two periods. Power was associated with the probability of being discharged dead (p = 0.03), longer mechanical ventilation (p < 0.001), and longer ICU stay (p = 0.035); cluster duration was associated with longer ICU stay (p = 0.027).

Conclusions: Clusters of double triggering and ineffective inspiratory efforts are common. Although higher numbers of clusters might indicate better chances of survival, clusters with greater power and duration indicate a risk of worse clinical outcomes.

Trial registration: ClinicalTrials.gov NCT03451461.

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Conflict of interest statement

Dr. Magrans is supported by a Torres Quevedo contract (PTQ2018-010120) from the Agencia Española de Investigacion, Spain. Dr. Sarlabous is supported by Pla Estratègic de Recerca i Innovació en Salut program from the Health Department of Generalitat de Catalunya, Spain. Dr. Blanch is inventor of a U.S. patent owned by the Corporació Sanitària Parc Taulí: “Method and system for managing related patient parameters provided by a monitoring device,” U.S. Patent No. 12/538,940. Drs. Montanyà and Blanch own stock options in BetterCare S.L., a research and development spinoff of Corporació Sanitària Parc Taulí (Spain). The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

    1. de Haro C, Ochagavia A, López-Aguilar J, et al.; Asynchronies in the Intensive Care Unit (ASYNICU) Group: Patient-ventilator asynchronies during mechanical ventilation: Current knowledge and research priorities. Intensive Care Med Exp. 2019; 7:43
    1. Esperanza JA, Sarlabous L, de Haro C, et al.: Monitoring asynchrony during invasive mechanical ventilation. Respir Care. 2020; 65:847–869
    1. Vassilakopoulos T, Petrof BJ: Ventilator-induced diaphragmatic dysfunction. Am J Respir Crit Care Med. 2004; 169:336–341
    1. Thille AW, Rodriguez P, Cabello B, et al.: Patient-ventilator asynchrony during assisted mechanical ventilation. Intensive Care Med. 2006; 32:1515–1522
    1. Pohlman MC, McCallister KE, Schweickert WD, et al.: Excessive tidal volume from breath stacking during lung-protective ventilation for acute lung injury. Crit Care Med. 2008; 36:3019–3023

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