Respiratory Entrainment and Reverse Triggering in a Mechanically Ventilated Patient

• Published in: Annals of the American Thoracic Society Vol. 16; no. 4; pp. 499 - 505
• Main Authors: de Vries, Heder J., Jonkman, Annemijn H., Tuinman, Pieter R., Girbes, Armand R. J., Heunks, Leo M. A.
• Format: Journal Article
• Language: English
• Published: United States American Thoracic Society 01.04.2019
• Subjects: Anesthesia; Carbon dioxide; Esophagus; Family medical history; Human subjects; Intensive care; Intubation; Respiration; Respiratory therapy; Ventilators
• ISSN: 2329-6933; 2325-6621; 2325-6621
• DOI: 10.1513/AnnalsATS.201811-767CC

Because the first response to a patient "fighting the ventilator" is often to increase sedation, it is essential to recognize this form of patient-ventilator interaction. [...]reducing sedation and changing respiratory rate, inspiratory pressure, and applied volume can disrupt entrainment and prevent reverse triggering. Unfortunately, these measures were ineffective in our patient. [...]the neuromuscular blocker rocuronium was administered to abolish respiratory muscle output and prevent reverse-triggered efforts with breath stacking. [...]reversetriggered breaths differ minimally in the timing, duration, and magnitude of inspiratory effort, which can be measured and quantified by either diaphragmatic electromyography or esophageal pressure measurements (Figure 3).