Additional work of breathing from trigger errors in mechanically ventilated children.

Abstract

BACKGROUND:

Patient-ventilator asynchrony is associated with increased morbidity and mortality. A direct causative relationship between Patient-ventilator asynchrony and adverse clinical outcome have yet to be demonstrated. It is hypothesized that during trigger errors excessive pleural pressure swings are generated, contributing to increased work-of-breathing and self-inflicted lung injury. The objective of this study was to determine the additional work-of-breathing and pleural pressure swings caused by trigger errors in mechanically ventilated children.

METHODS:

Prospective observational study in a tertiary paediatric intensive care unit in an university hospital. Patients ventilated > 24 h and < 18 years old were studied. Patients underwent a 5-min recording of the ventilator flow-time, pressure-time and oesophageal pressure-time scalar. Pressure-time-product calculations were made as a proxy for work-of-breathing. Oesophageal pressure swings, as a surrogate for pleural pressure swings, during trigger errors were determined.

RESULTS:

Nine-hundred-and-fifty-nine trigger errors in 28 patients were identified. The additional work-of-breathing caused by trigger errors showed great variability among patients. The more asynchronous breaths were present the higher the work-of-breathing of these breaths. A higher spontaneous breath rate led to a lower amount of trigger errors. Patient-ventilator asynchrony was not associated with prolonged duration of mechanical ventilation or paediatric intensive care stay.

CONCLUSIONS:

The additional work-of-breathing caused by trigger errors in ventilated children can take up to 30-40% of the total work-of-breathing. Trigger errors were less common in patients breathing spontaneously and those able to generate higher pressure-time-product and pressure swings.

TRIAL REGISTRATION:

Not applicable.

• Authors: Robert G T Blokpoel, Alette A Koopman, Jefta van Dijk, Martin C J Kneyber
• Journal: Respiratory research (Respir Res) Vol. 21 Issue 1 Pg. 296 (Nov 10 2020) ISSN: 1465-993X [Electronic] England
• PMID: 33172465 (Publication Type: Journal Article, Observational Study)

Topics

• Age Factors
• Female
• Humans
• Infant
• Intensive Care Units, Pediatric
• Lung (physiopathology)
• Lung Injury (etiology, physiopathology)
• Male
• Pressure
• Prospective Studies
• Respiration, Artificial (adverse effects)
• Time Factors
• Work of Breathing