The Effect of Clusters of Double Triggering and Ineffective Efforts in Critically Ill Patients

OBJECTIVES:

To characterize clusters of double triggering and ineffective inspiratory efforts throughout mechanical ventilation and investigate their associations with mortality and duration of ICU stay and mechanical ventilation.

DESIGN:

Registry-based, real-world study.

Background:

Asynchronies during invasive mechanical ventilation can occur as isolated events or in clusters and might be related to clinical outcomes.

Subjects:

Adults requiring mechanical ventilation greater than 24 hours for whom greater than or equal to 70% of ventilator waveforms were available.

INTERVENTIONS:

We identified clusters of double triggering and ineffective inspiratory efforts and determined their power and duration. We used Fine-Gray’s competing risk model to analyze their effects on mortality and generalized linear models to analyze their effects on duration of mechanical ventilation and ICU stay.

MEASUREMENTS AND MAIN RESULTS:

We analyzed 58,625,796 breaths from 180 patients. All patients had clusters (mean/d, 8.2 [5.4–10.6]; mean power, 54.5 [29.6–111.4]; mean duration, 20.3 min [12.2–34.9 min]). Clusters were less frequent during the first 48 hours (5.5 [2.5–10] vs 7.6 [4.4–9.9] in the remaining period [p = 0.027]). Total number of clusters/d was positively associated with the probability of being discharged alive considering the total period of mechanical ventilation (p = 0.001). Power and duration were similar in the two periods. Power...

Source: Critical Care Medicine - June 24, 2022 Category: Emergency Medicine Tags: Online Clinical Investigations Source Type: research