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Intensive Care Medicine

, Volume 42, Issue 6, pp 1058–1061 | Cite as

Does this ventilated patient have asynchronies? Recognizing reverse triggering and entrainment at the bedside

  • Gastón Murias
  • Candelaria de Haro
  • Lluis BlanchEmail author
What's New in Intensive Care

Reverse triggering is a frequently under-recognized form of patient–ventilatory asynchrony in which the patient’s respiratory center is activated in response to a passive insufflation of the lungs. It can be detected at the bedside by observing airway pressure and airflow waveforms.

Figure  1a and video 1 (in the electronic supplementary material, ESM) show airway pressure and flow waveforms from a patient ventilated in volume-control mode. The breaths are almost certainly machine triggered because no perturbation in airway pressure can be seen at the beginning of the breath. At first sight, the records seem quite normal. However, a closer look shows that breaths marked with arrows are slightly different from other breaths. The airway pressure waveform shows a fall during the inspiratory plateau. Provided there are no air leaks, the amount of gas inside the respiratory system is constant (both the inspiratory and expiratory valves are closed), and a decrease in airway pressure denotes...

Keywords

Airway Pressure Peak Expiratory Flow Pressure Waveform Inspiratory Muscle Flow Waveform 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Financial support

This work was funded by projects ISCIII PI09/91074 and PI13/02204 integrated into the Plan Estatal de I+D+I 2013–2016 and funded by the ISCIII-Subdirección General de Evaluación y Fomento de la Investigación el Fondo Europeo de Desarrollo Regional (FEDER), CIBER Enfermedades Respiratorias, Fundación Mapfre, Fundació Parc Taulí, Plan Avanza TSI-020302-2008-38, MCYIN and MITYC (Spain).

Compliance with ethical standards

Conflicts of interest

Murias and Blanch are inventors of one Corporació Sanitaria Parc Taulí owned US patent: “Method and system for managed related patient parameters provided by a monitoring device,” US Patent No. 12/538,940. Murias and Blanch own stock options of BetterCare S.L., which is a research and development spin-off of Corporació Sanitària Parc Taulí (Spain). Candelaria de Haro has no conflicts of interest.

Supplementary material

Supplementary material 1 (MP4 17086 kb)

Supplementary material 2 (MP4 15667 kb)

Supplementary material 3 (MP4 16313 kb)

Supplementary material 4 (MP4 17083 kb)

134_2015_4177_MOESM5_ESM.docx (146 kb)
Supplementary material 5 (DOCX 146 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  • Gastón Murias
    • 1
  • Candelaria de Haro
    • 2
    • 3
  • Lluis Blanch
    • 2
    • 3
    • 4
    • 5
    Email author
  1. 1.Clínica Bazterrica y Clínica Santa IsabelBuenos AiresArgentina
  2. 2.Critical Care Center, Hospital de SabadellCorporació Sanitaria Universitària Parc TaulíSabadellSpain
  3. 3.Institut de Investigació i Innovació Parc TaulíUniversitat Autònoma de BarcelonaSabadellSpain
  4. 4.CIBER Enfermedades Respiratorias, ISCIIIMadridSpain
  5. 5.Fundació Parc TaulíCorporació Sanitaria Universitària Parc TaulíSabadellSpain

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