Mechanical Ventilation-Induced Reverse-Triggered Breaths A Frequently Unrecognized Form of Neuromechanical Coupling
Mechanical Ventilation-Induced Reverse-Triggered Breaths A Frequently Unrecognized Form of Neuromechanical Coupling
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DOI：
10.1378/chest.12-1817
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发表时间：
2013-04-01
期刊：
影响因子：
9.6
通讯作者：
Richard, Jean-Christophe Marie
中科院分区：
文献类型：
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作者：
Akoumianaki, Evangelia;Lyazidi, Aissam;Richard, Jean-Christophe Marie
工作背景：由呼吸机吹入触发的膈肌收缩构成了被称为"夹带"的患者-呼吸机相互作用的形式，这在危重患者中通常是未被识别的。我们的目的是审查描记，其中也包括肌肉活动，获得镇静患者谁是机械通气，以描述夹带事件及其特点。术语"反向触发"被采用来描述呼吸机触发的muscle efforts. Methods：在3个月的时间内，记录包含流量，气道压力，食管压力或电活动的隔膜进行了审查。记录来自A。一系列连续的重度镇静患者，采用辅助控制通气模式通气治疗ARDS。夹带的持续时间。夹带比，和呼吸机和神经呼吸的开始之间的相位差消逝evaluated.Results：8个连续的ARDS患者的描记进行了审查，他们都表现出不同形式的夹带。反向触发发生在总记录周期的12%至100%的部分上。7例患者的机械吹气与血管收缩比率为1：1; 1例患者的比率为1：2，另1例患者的比率为1：2和1：3。1例患者仅表现出1：2的比例。反向触发呼吸频率的平均变异系数为
Background: Diaphragmatic muscle contractions triggered by ventilator insufflations constitute a form of patient-ventilator interaction referred to as "entrainment," which is usually unrecognized in critically ill patients. Our objective was to review tracings, which also included muscular activity, obtained in sedated patients who were mechanically ventilated to describe the entrainment events and their characteristics. The term "reverse triggering" was adopted to describe the ventilator-triggered muscular efforts.Methods: Over a 3-month period, recordings containing flow, airway pressure, and esophageal pressure or electrical activity of the diaphragm were reviewed. Recordings were obtained from a. series of consecutive heavily sedated patients ventilated with an assist-control Mode of ventilation for ARDS. The duration of entrainment, the. entrainment ratio, and the phase difference elapsing between the commencement of the ventilator and neural breaths were evaluated.Results: The tracings of eight consecutive patients with ARDS were reviewed; they all showed different forms of entrainment. Reverse triggering occurred over a portion varying from 12% to 100% of the total recording period. Seven patients had a 1:1 mechanical insufflation to diaphragmatic contractions ratio; this coexisted with a 1:2 ratio in one patient and 1:2 and 1:3 ratios in another. One patient exhibited only a 1:2 ratio. The frequency of reverse-triggered breaths had a mean coefficient of variability of