Post-insufflation diaphragm contractions in patients receiving various modes of mechanical ventilation

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dc.article.number310
dc.catalogadorpva
dc.contributor.authorRodrigues, Antenor
dc.contributor.authorVieira, Fernando
dc.contributor.authorSklar, Michael Chaim
dc.contributor.authorDamiani Rebolledo, L. Felipe
dc.contributor.authorPiraino, Thomas
dc.contributor.authorTelias, Irene
dc.contributor.authorGoligher, Ewan C.
dc.contributor.authorReid, W. Darlene
dc.contributor.authorBrochard, Laurent
dc.date.accessioned2024-09-24T13:01:36Z
dc.date.available2024-09-24T13:01:36Z
dc.date.issued2024
dc.date.updated2024-09-22T00:02:16Z
dc.description.abstractBackground: During mechanical ventilation, post-insufflation diaphragm contractions (PIDCs) are non-physiologic and could be injurious. PIDCs could be frequent during reverse-triggering, where diaphragm contractions follow the ventilator rhythm. Whether PIDCs happens with different modes of assisted ventilation is unknown. In mechanically ventilated patients with hypoxemic respiratory failure, we aimed to examine whether PIDCs are associated with ventilator settings, patients’ characteristics or both. Methods: One-hour recordings of diaphragm electromyography (EAdi), airway pressure and flow were collected once per day for up to five days from intubation until full recovery of diaphragm activity or death. Each breath was classified as mandatory (without-reverse-triggering), reverse-triggering, or patient triggered. Reverse triggering was further subclassified according to EAdi timing relative to ventilator cycle or reverse triggering leading to breath-stacking. EAdi timing (onset, offset), peak and neural inspiratory time (Tineuro) were measured breath-by-breath and compared to the ventilator expiratory time. A multivariable logistic regression model was used to investigate factors independently associated with PIDCs, including EAdi timing, amplitude, Tineuro, ventilator settings and APACHE II. Results: Forty-seven patients (median[25%-75%IQR] age: 63[52–77] years, BMI: 24.9[22.9–33.7] kg/m2, 49% male, APACHE II: 21[19–28]) contributed 2 ± 1 recordings each, totaling 183,962 breaths. PIDCs occurred in 74% of reverse-triggering, 27% of pressure support breaths, 21% of assist-control breaths, 5% of Neurally Adjusted Ventilatory Assist (NAVA) breaths. PIDCs were associated with higher EAdi peak (odds ratio [OR][95%CI] 1.01[1.01;1.01], longer Tineuro (OR 37.59[34.50;40.98]), shorter ventilator inspiratory time (OR 0.27[0.24;0.30]), high peak inspiratory flow (OR 0.22[0.20;0.26]), and small tidal volumes (OR 0.31[0.25;0.37]) (all P ≤ 0.008). NAVA was associated with absence of PIDCs (OR 0.03[0.02;0.03]; P < 0.001). Reverse triggering was characterized by lower EAdi peak than breaths triggered under pressure support and associated with small tidal volume and shorter set inspiratory time than breaths triggered under assist-control (all P < 0.05). Reverse triggering leading to breath stacking was characterized by higher peak EAdi and longer Tineuro and associated with small tidal volumes compared to all other reverse-triggering phenotypes (all P < 0.05). Conclusions: In critically ill mechanically ventilated patients, PIDCs and reverse triggering phenotypes were associated with potentially modifiable factors, including ventilator settings. Proportional modes like NAVA represent a solution abolishing PIDCs.
dc.fechaingreso.objetodigital2024-09-22
dc.fuente.origenAutoarchivo
dc.identifier.citationCritical Care. 2024 Sep 18;28(1):310
dc.identifier.doi10.1186/s13054-024-05091-y
dc.identifier.issn1364-8535
dc.identifier.urihttps://doi.org/10.1186/s13054-024-05091-y
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/87918
dc.information.autorucEscuela de Medicina; Damiani Rebolledo, L. Felipe; 0000-0002-8338-0488; 237645
dc.issue.numero1
dc.language.isoen
dc.nota.accesocontenido completo
dc.pagina.final14
dc.pagina.inicio1
dc.revistaCritical Care
dc.rightsacceso abierto
dc.rights.holderThe Author(s)
dc.rights.licenseAttribution 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectRespiration
dc.subjectArtifcial
dc.subjectPatient-ventilator asynchrony
dc.subjectDiaphragm
dc.subjectMuscle contraction
dc.subject.ddc610
dc.subject.deweyMedicina y saludes_ES
dc.subject.ods03 Good health and well-being
dc.subject.odspa03 Salud y bienestar
dc.titlePost-insufflation diaphragm contractions in patients receiving various modes of mechanical ventilation
dc.typeartículo
dc.volumen28
sipa.codpersvinculados237645
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