PT  - JOURNAL ARTICLE
AU  - Liao, Kuang-Ming
AU  - Ou, Chih-Ying
AU  - Chen, Chang-Wen
TI  - Classifying Different Types of Double Triggering Based on Airway Pressure and Flow Deflection in Mechanically Ventilated Patients
AID  - 10.4187/respcare.00731
DP  - 2011 Apr 01
TA  - Respiratory Care
PG  - 460--466
VI  - 56
IP  - 4
4099  - http://rc.rcjournal.com/content/56/4/460.short
4100  - http://rc.rcjournal.com/content/56/4/460.full
AB  - BACKGROUND: Double-triggering (DT) is a frequent type of patient-ventilator asynchrony and has potentially severe consequences, such as alveolar overdistention or the generation of intrinsic PEEP. However, the first breath of DT could be patient-triggered (DT-P), auto-triggered (DT-A), or ventilator-triggered (DT-V). OBJECTIVE: To differentiate DT-P, DT-A, and DT-V using airway pressure or flow changes during the trigger-delay phase in ventilated patients. METHODS: Fourteen mechanically ventilated patients with DT were included. All patients were on flow-triggered ventilation modes and received either continuous mandatory ventilation or pressure support ventilation. Breaths in which the first breath was associated with an esophageal pressure drop of > 1 cm H2O were categorized as DT-P. Breaths in which the first breath occurred at the ventilator set cycle were categorized as DT-V. Breaths in which the first breath occurred earlier than the ventilator set cycle without esophageal pressure drop were categorized as DT-A. The pressure drop and flow change at 0.13 s (PD0.13 and F0.13, respectively) in the trigger-delay phase were calculated from the nadir. RESULTS: There were 507 double-triggered breaths: 271 DT-V (53%), 50 DT-A (10%), and 186 DT-P (37%). The PD0.13 for DT-V, DT-A, and DT-P were 0.16 ± 0.12 cm H2O, 0.25 ± 0.17 cm H2O, and 1.34 ± 0.67 cm H2O, respectively. The F0.13 for DT-V, DT-A, and DT-P were 2.11 ± 2.31 L/min, 2.64 ± 2.07 L/min, and 16.51 ± 8.02 L/min, respectively. The best discriminatory criteria for differentiating DT-P from DT-V and DT-A, based on the Youden index (sensitivity + specificity – 1) was PD0.13 ≥ 0.49 cm H2O, which had a Youden index of 95%. CONCLUSION: DT-P can be distinguished from DT-V and DT-A by using airway pressure deflections in the trigger-delay phase.