Ineffective triggering predicts increased duration of mechanical  ventilation.
OBJECTIVE
To determine whether high rates of ineffective triggering within the first 24 hrs of mechanical ventilation (MV) are associated with longer MV duration and shorter ventilator-free survival (VFS).


METHODS
Prospective cohort study.


METHODS
Medical intensive care unit (ICU) at an academic medical center.


METHODS
Sixty patients requiring invasive MV.


METHODS
None.


METHODS
Patients had pressure-time and flow-time waveforms recorded for 10 mins within the first 24 hrs of MV initiation. Ineffective triggering index (ITI) was calculated by dividing the number of ineffectively triggered breaths by the total number of breaths (triggered and ineffectively triggered). A priori, patients were classified into ITI >or=10% or ITI <10%. Patient demographics, MV reason, codiagnosis of chronic obstructive pulmonary disease (COPD), sedation levels, and ventilator parameters were recorded.


RESULTS
Sixteen of 60 patients had ITI >or=10%. The two groups had similar characteristics, including COPD frequency and ventilation parameters, except that patients with ITI >or=10% were more likely to have pressured triggered breaths (56% vs. 16%, p = .003) and had a higher intrinsic respiratory rate (22 breaths/min vs. 18, p = .03), but the set ventilator rate was the same in both groups (9 breaths/min vs. 9, p = .78). Multivariable analyses adjusting for pressure triggering also demonstrated that ITI >or=10% was an independent predictor of longer MV duration (10 days vs. 4, p = .0004) and shorter VFS (14 days vs. 21, p = .03). Patients with ITI >or=10% had a longer ICU length of stay (8 days vs. 4, p = .01) and hospital length of stay (21 days vs. 8, p = .03). Mortality was the same in the two groups, but patients with ITI >or=10% were less likely to be discharged home (44% vs. 73%, p = .04).


CONCLUSIONS
Ineffective triggering is a common problem early in the course of MV and is associated with increased morbidity, including longer MV duration, shorter VFS, longer length of stay, and lower likelihood of home discharge.
de Wit
Marjolein
M
Division of Pulmonary Disease and Critical Care Medicine, Virginia Commonwealth University, Richmond, VA, USA. mdewit@mcvh-vcu.edu
Miller
Kristin B
KB
Green
David A
DA
Ostman
Henry E
HE
Gennings
Chris
C
Epstein
Scott K
SK
D018806:APACHE; D000368:Aged; D016292:Procedural Sedation; D019544:Equipment Failure Analysis; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D018467:Positive-Pressure Respiration, Intrinsic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D012129:Respiratory Function Tests; D012307:Risk Factors; D012815:Signal Processing, Computer-Assisted; D016019:Survival Analysis; D016896:Treatment Outcome; D015300:Ventilator Weaning; D012122:Ventilators, Mechanical
D010100:Oxygen