切换至 "中华医学电子期刊资源库"

第五届中国出版政府奖音像电子网络出版物奖提名奖

中国科技核心期刊

中国科学引文数据库(CSCD)来源期刊

中华重症医学电子杂志 ›› 2023, Vol. 09 ›› Issue (01) : 19 -24. doi: 10.3877/cma.j.issn.2096-1537.2023.01.004

专题笔谈

反转触发:易被忽视的人机不同步
李宏亮1, 周建新2,()   
  1. 1. 100070 北京,首都医科大学附属北京天坛医院重症医学科
    2. 100070 北京,首都医科大学附属北京天坛医院重症医学科;100038 北京,首都医科大学附属北京世纪坛医院重症医学科
  • 收稿日期:2022-09-22 出版日期:2023-02-28
  • 通信作者: 周建新
  • 基金资助:
    首都临床诊疗技术研究及转化应用项目(Z201100005520079)

Reverse triggering: the easily overlooked patient-ventilator asynchrony

Hongliang Li1, Jianxin Zhou2,()   

  1. 1. Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
    2. Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; Department of Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
  • Received:2022-09-22 Published:2023-02-28
  • Corresponding author: Jianxin Zhou
引用本文:

李宏亮, 周建新. 反转触发:易被忽视的人机不同步[J/OL]. 中华重症医学电子杂志, 2023, 09(01): 19-24.

Hongliang Li, Jianxin Zhou. Reverse triggering: the easily overlooked patient-ventilator asynchrony[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2023, 09(01): 19-24.

在众多的人机不同步类型中,源于呼吸拖带所致的反转触发是一种较为独特的存在,除具有高度的隐匿性之外,如果成功触发呼吸机导致呼吸叠加,将会在控制性机械通气的预期之外提供更大的潮气量和更高的跨肺压,从而引起呼吸机相关肺损伤,并且对膈肌功能也产生一定的影响。本文从流行病学、病理生理学机制、临床意义及分型、识别及干预措施等角度对其研究现状进行综述,旨在提高临床医师的重视程度,并希望以此推动相关临床及基础研究的开展。

Among many types of patient-ventilator asynchrony, reverse triggering derived from respiratory entrainment is a unique existence. It's challenging to identify reverse triggering in clinical scenario. What's more, if the ventilator is triggered successfully, it is also called breath stacking. In that case, the increased tidal volume or transpulmonary pressure will lead to ventilator-induced lung injury and influence function of the diaphragm. We have reviewed the epidemiology, pathophysiology mechanisms, phenotypes, clinical significance, and management strategies of reverse triggering, aiming to improve clinical physicians' awareness and facilitate fundamental and clinical research.

图1 呼吸拖带示意图(容量控制通气模式,恒定送气流速)。图a为呼吸机流速-时间曲线;图b为食管内压-时间曲线。可见患者自主的神经吸气努力均发生在呼气相,对应的呼气峰流速较完全性控制通气时明显减小;每2次呼吸机控制性通气后出现一次神经吸气努力,拖带比为1∶2。红色虚线代表周期性呼吸机控制性通气的开始,绿色虚线代表拖带出的神经吸气努力的开始,两者之间的差值即为相位差(dP)。相位差和呼吸机通气周期的比值与360°的乘积即为相位角(θ)
1
Thille AW, Rodriguez P, Cabello B, et al. Patient-ventilator asynchrony during assisted mechanical ventilation [J]. Intensive Care Med, 2006, 32(10) : 1515-1522.
2
Blanch L, Villagra A, Sales B, et al. Asynchronies during mechanical ventilation are associated with mortality [J]. Intensive Care Med, 2015, 41(4) : 633-641.
3
Kyo M, Shimatani T, Hosokawa K, et al. Patient-ventilator asynchrony, impact on clinical outcomes and effectiveness of interventions: a systematic review and meta-analysis [J]. J Intensive Care, 2021, 9(1) : 50.
4
Ramírez II, Adasme RS, Arellano DH, et al. Identifying and managing patient-ventilator asynchrony: an international survey [J]. Med Intensiva (Engl Ed), 2021, 45(3) : 138-146.
5
Akoumianaki E, Lyazidi A, Rey N, et al. Mechanical ventilation-induced reverse-triggered breaths: a frequently unrecognized form of neuromechanical coupling [J]. Chest, 2013, 143(4) : 927-938.
6
de Haro C, Lopez-Aguilar J, Magrans R, et al. Double cycling during mechanical ventilation: frequency, mechanisms, and physiologic implications [J]. Crit Care Med, 2018, 46(9) : 1385-1392.
7
Telias I, Beitler JR. Reverse triggering, the rhythm dyssynchrony: potential implications for lung and diaphragm protection [J]. Am J Respir Crit Care Med, 2021, 203(1) : 5-6.
8
de Vries HJ, Jonkman AH, Tuinman PR, et al. Respiratory entrainment and reverse triggering in a mechanically ventilated patient [J]. Ann Am Thorac Soc, 2019, 16(4) : 499-505.
9
Rodriguez PO, Tiribelli N, Fredes S, et al. Prevalence of reverse triggering in early ARDS: results from a multicenter observational study [J]. Chest, 2021, 159(1) : 186-195.
10
Mellado Artigas R, Damiani LF, Piraino T, et al. Reverse triggering dyssynchrony 24 h after initiation of mechanical ventilation [J]. Anesthesiology, 2021, 134(5) : 760-769.
11
Bourenne J, Guervilly C, Mechati M, et al. Variability of reverse triggering in deeply sedated ARDS patients [J]. Intensive Care Med, 2019, 45(5) : 725-726.
12
Sklar MC, Madotto F, Jonkman A, et al. Duration of diaphragmatic inactivity after endotracheal intubation of critically ill patients [J]. Crit Care, 2021, 25(1) : 26.
13
Baedorf Kassis E, Su HK, Graham AR, et al. Reverse trigger phenotypes in acute respiratory distress syndrome [J]. Am J Respir Crit Care Med, 2021, 203(1) : 67-77.
14
Pham T, Montanya J, Telias I, et al. Automated detection and quantification of reverse triggering effort under mechanical ventilation [J]. Crit Care, 2021, 25(1) : 60.
15
Su HK, Loring SH, Talmor D, et al. Reverse triggering with breath stacking during mechanical ventilation results in large tidal volumes and transpulmonary pressure swings [J]. Intensive Care Med, 2019, 45(8): 1161-1162.
16
Talmor D, Sarge T, Malhotra A, et al. Mechanical ventilation guided by esophageal pressure in acute lung injury [J]. N Engl J Med, 2008, 359(20) : 2095-2104.
17
Lin Z, Zhou J, Lin X, et al. Reverse trigger in ventilated non-ARDS patients: a phenomenon can not be ignored! [J]. Front Physiol, 2021, 12 : 670172.
18
Blokpoel RGT, Wolthuis DW, Koopman AA, et al. Reverse triggering: a novel type of patient-ventilator asynchrony in mechanically ventilated children [J]. Am J Respir Crit Care Med, 2019, 200(2) : e4-e5.
19
Shimatani T, Yoon B, Kyogoku M, et al. Frequency and risk factors for reverse triggering in pediatric acute respiratory distress syndrome during synchronized intermittent mandatory ventilation [J]. Ann Am Thorac Soc, 2021, 18(5) : 820-829.
20
Longobardo G, Evangelisti CJ, Cherniack NS. Introduction of respiratory pattern generators into models of respiratory control [J]. Respir Physiol Neurobiol, 2005, 148(3) : 285-301.
21
Murias G, de Haro C, Blanch L. Does this ventilated patient have asynchronies? Recognizing reverse triggering and entrainment at the bedside [J]. Intensive Care Med, 2016, 42(6) : 1058-1061.
22
Sassoon CS, Mancebo J. The double-edged sword of reverse triggering: impact on the diaphragm [J]. Am J Respir Crit Care Med, 2022, 205(6) : 606-608.
23
Simon PM, Habel AM, Daubenspeck JA, et al. Vagal feedback in the entrainment of respiration to mechanical ventilation in sleeping humans [J]. J Appl Physiol (1985), 2000, 89(2) : 760-769.
24
Simon PM, Zurob AS, Wies WM, et al. Entrainment of respiration in humans by periodic lung inflations. Effect of state and CO2 [J]. Am J Respir Crit Care Med, 1999, 160(3) : 950-960.
25
Petrillo GA, Glass L, Trippenbach T. Phase locking of the respiratory rhythm in cats to a mechanical ventilator [J]. Can J Physiol Pharmacol, 1983, 61(6) : 599-607.
26
Graves C, Glass L, Laporta D, et al. Respiratory phase locking during mechanical ventilation in anesthetized human subjects [J]. Am J Physiol, 1986, 250(5 Pt 2) : R902-R909.
27
Levy M, Tabone L, Mortamet G, et al. Not all breaths that follow a ventilator cycle are reverse triggering [J]. Ann Am Thorac Soc, 2021, 18(7) : 1263-1264.
28
Shimatani T, Yoon B, Hotz JC, et al. Reply: not all breaths that follow a ventilator cycle are reverse triggering [J]. Ann Am Thorac Soc, 2021, 18(7) : 1264-1266.
29
Vibert JF, Caille D, Segundo JP. Respiratory oscillator entrainment by periodic vagal afferentes: an experimental test of a model [J]. Biol Cybern, 1981, 41(2) : 119-130.
30
Delisle S, Charbonney E, Albert M, et al. Patient-ventilator asynchrony due to reverse triggering occurring in brain-dead patients: clinical implications and physiological meaning [J]. Am J Respir Crit Care Med, 2016, 194(9) : 1166-1168.
31
Dubayle D, Viala D. Localization of the spinal respiratory rhythm generator by an in vitro electrophysiological approach [J]. Neuroreport, 1996, 7(6) : 1175-1180.
32
Itagaki T, Ueno Y, Nakanishi N, et al. Reverse triggering induced by endotracheal tube leak in lightly sedated ARDS patient [J]. J Intensive Care, 2018, 6 : 41.
33
Turbil E, Guerin C, Schwebel C, et al. Reverse triggering: sometimes it is not only the diaphragm [J]. Am J Respir Crit Care Med, 2020, 201(7) : e24-e25.
34
Mauri T, Foti G, Fornari C, et al. Sigh in patients with acute hypoxemic respiratory failure and ARDS: the PROTECTION pilot randomized clinical trial [J]. Chest, 2021, 159(4) : 1426-1436.
35
Yoshida T, Torsani V, Gomes S, et al. Spontaneous effort causes occult pendelluft during mechanical ventilation [J]. Am J Respir Crit Care Med, 2013, 188(12) : 1420-1427.
36
Yoshida T, Nakamura MAM, Morais CCA, et al. Reverse triggering causes an injurious inflation pattern during mechanical ventilation [J]. Am J Respir Crit Care Med, 2018, 198(8) : 1096-1099.
37
Pohlman MC, McCallister KE, Schweickert WD, et al. Excessive tidal volume from breath stacking during lung-protective ventilation for acute lung injury [J]. Crit Care Med, 2008, 36(11) : 3019-3023.
38
Schreiber A, Bertoni M, Goligher EC. Avoiding respiratory and peripheral muscle injury during mechanical ventilation: diaphragm-protective ventilation and early mobilization [J]. Crit Care Clin, 2018, 34(3) : 357-381.
39
Damiani LF, Engelberts D, Bastia L, et al. Impact of reverse triggering dyssynchrony during lung-protective ventilation on diaphragm function: an experimental model [J]. Am J Respir Crit Care Med, 2022, 205(6) : 663-673.
40
Goligher EC, Fan E, Herridge MS, et al. Evolution of diaphragm thickness during mechanical ventilation. impact of inspiratory effort [J]. Am J Respir Crit Care Med, 2015, 192(9) : 1080-1088.
41
Ramirez, II, Arellano DH, Adasme RS, et al. Ability of ICU health-care professionals to identify patient-ventilator asynchrony using waveform analysis [J]. Respir Care, 2017, 62(2) : 144-149.
42
Rodriguez PO, Tiribelli N, Gogniat E, et al. Automatic detection of reverse-triggering related asynchronies during mechanical ventilation in ARDS patients using flow and pressure signals [J]. J Clin Monit Comput, 2020, 34(6) : 1239-1246.
43
Chanques G, Kress JP, Pohlman A, et al. Impact of ventilator adjustment and sedation-analgesia practices on severe asynchrony in patients ventilated in assist-control mode [J]. Crit Care Med, 2013, 41(9) : 2177-2187.
44
Sottile PD, Albers D, Higgins C, et al. The association between ventilator dyssynchrony, delivered tidal volume, and sedation using a novel automated ventilator dyssynchrony detection algorithm [J]. Crit Care Med, 2018, 46(2) : e151-e157.
45
Yonis H, Gobert F, Tapponnier R, et al. Reverse triggering in a patient with ARDS [J]. Intensive Care Med, 2015, 41(9) : 1711-1712.
46
Jochmans S, Mazerand S, Mercier des Rochettes E, et al. Reverse triggering with breath stacking in ARDS patients: the "optimum" can be the enemy of the "good" [J]. Minerva Anestesiol, 2018, 84(7) : 871-872.
47
He X, Luo XY, Chen GQ, et al. Detection of reverse triggering in a 55-year-old man under deep sedation and controlled mechanical ventilation [J]. J Thorac Dis, 2018, 10(9) : E682-E685.
48
Yu J. Deflation-activated receptors, not classical inflation-activated receptors, mediate the Hering-Breuer deflation reflex [J]. J Appl Physiol (1985), 2016, 121(5) : 1041-1046.
49
Morais CCA, Koyama Y, Yoshida T, et al. High positive end-expiratory pressure renders spontaneous effort noninjurious [J]. Am J Respir Crit Care Med, 2018, 197(10) : 1285-1296.
[1] 薛翔, 陈娇, 贾凌, 杨敬辉, 蔡建芹, 陈昆仑, 赵炜. 肺内叩击通气在上腹部术后机械通气患者中的疗效分析[J/OL]. 中华危重症医学杂志(电子版), 2023, 16(06): 469-474.
[2] 豆艺璇, 黄怀, 钱绮雯, 邢然然, 林丽, 白建芳. 低强度吸气肌训练对机械通气患者肺康复的影响[J/OL]. 中华危重症医学杂志(电子版), 2023, 16(05): 370-375.
[3] 徐娟, 孙汝贤, 赵东亚, 张清艳, 金兆辰, 蔡燕. 右美托咪定序贯镇静模式对中深度镇静的机械通气患者预后和谵妄的影响[J/OL]. 中华危重症医学杂志(电子版), 2023, 16(05): 363-369.
[4] 张璇, 高杨, 房雅君, 姚艳玲. 保护性机械通气在肺癌胸腔镜肺段切除术中的临床应用[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 563-567.
[5] 彭祺, 马丽娜, 李倩倩, 陈旭. 重症病毒性肺炎机械通气脱机的影响因素分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(02): 260-263.
[6] 叶观生, 黄潘文, 莫伟良, 钟许昌. 序贯NCPAP、HHFNC对肺炎并发呼吸衰竭氧合指数的影响[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(01): 99-102.
[7] 潘清, 葛慧青. 基于机械通气波形大数据的人机不同步自动监测方法[J/OL]. 中华重症医学电子杂志, 2024, 10(04): 399-403.
[8] 韦小霞, 陈管洁, 李雪珠, 李晓青, 钱淑媛. 机械通气患者抗菌药物雾化吸入的临床实施[J/OL]. 中华重症医学电子杂志, 2024, 10(04): 334-337.
[9] 苗明月, 周建新. 肺保护性镇静:应重视呼吸驱动和吸气努力的床旁评估[J/OL]. 中华重症医学电子杂志, 2024, 10(04): 325-328.
[10] 倪韫晖, 杨毅, 袁雪燕, 邱海波. 胸壁加压在急性呼吸窘迫综合征中的应用和临床进展[J/OL]. 中华重症医学电子杂志, 2024, 10(03): 243-247.
[11] 刘春峰, 徐朝晖, 施红伟, 陈瑢, 马腾飞, 李鹏飞, 袁蓉, 陈建荣, 徐爱明. 机械通气患者肌肉减少症的诊断及其对预后的影响[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 820-825.
[12] 王文珠, 刘建, 袁常秀, 石亚飞, 尤培军. 竖脊肌平面阻滞对非体外循环冠状动脉旁路移植术中阿片类药物用量的影响[J/OL]. 中华诊断学电子杂志, 2024, 12(03): 155-159.
[13] 李春光, 杨洋, 李斌, 华荣, 孙益峰, 李志刚. 不同外科修复模式治疗机械通气相关气管食管瘘的短期疗效评价[J/OL]. 中华胸部外科电子杂志, 2024, 11(03): 151-157.
[14] 刘晴雯, 韩勇, 陈丽丹, 邓哲. 早期机械通气对成人院内心脏骤停病死率的影响:一项回顾性队列研究[J/OL]. 中华卫生应急电子杂志, 2024, 10(04): 203-206.
[15] 刘晓鹏, 柳聪艳, 杨宁, 蔡琛, 李晓兵, 王红宇, 张思森. 三穴五针联合腹部提压法在机械通气患者肺康复中的疗效[J/OL]. 中华卫生应急电子杂志, 2024, 10(04): 193-198.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?