title: Mechanical ventilation and the total artificial heart: optimal ventilator trigger to avoid post-operative autocycling - a case series and literature review.
abstract: Many patients with end-stage cardiomyopathy are now being implanted with Total Artificial Hearts (TAHs). We have observed individual cases of post-operative mechanical ventilator autocycling with a flow trigger, and subsequent loss of autocycling after switching to a pressure trigger. These observations prompted us to do a retrospective review of all TAH devices placed at our institution between August 2007 and May 2009. We found that in the immediate post-operative period following TAH placement, autocycling was present in 50% (5/10) of cases. There was immediate cessation of autocycling in all patients after being changed from a flow trigger of 2 L/minute to a pressure trigger of 2 cm H2O. The autocycling group was found to have significantly higher CVP values than the non-autocycling group (P = 0.012). Our data suggest that mechanical ventilator autocycling may be resolved or prevented by the use of a pressure trigger rather than a flow trigger setting in patients with TAHs who require mechanical ventilation.
authors.affiliation: Department of Anesthesiology, Mayo Clinic Arizona, 5777 East Mayo Boulevard, Phoenix, Arizona 85054, USA. allenshoham@gmail.com
authors.forename: Allen B
authors.initials: AB
authors.lastname: Shoham
authors.forename: Bhavesh
authors.initials: B
authors.lastname: Patel
authors.forename: Francisco A
authors.initials: FA
authors.lastname: Arabia
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Murray
mesh_terms: D000328:Adult; D006354:Heart, Artificial; D006801:Humans; D007442:Intubation, Intratracheal; D011175:Positive-Pressure Respiration; D012123:Pulmonary Ventilation; D012121:Respiration, Artificial / Q000379:methods*