The following is a summary of “Reverse triggering: a novel or previously missed phenomenon?,” published in the May 2024 issue of Critical Care by Jackson et al.
Reverse triggering (RT), identified in 2013, is a type of patient-ventilator asynchrony where the patient’s respiratory effort follows mechanical insufflation, diagnosed using esophageal pressure (Pes), diaphragmatic electrical activity (EAdi), or standard ventilator waveforms.
Researchers conducted a retrospective study investigating the historical prevalence and detection rate of RT in patients who were ventilated, with a specific focus on the period before 2013 and the era of low tidal volumes after 2000.
They analyzed ventilator waveforms from published studies (1950-2017) identified through a literature search in PubMed, EMBASE, and Cochrane Central Register of Controlled Trials. Experts labeled waveforms as “definite” RT using EAdi or “possible” RT based solely on Pes Labels were compared to the authors’ original descriptions of the waveforms.
The result showed 65 relevant papers published from 1977 till the present, containing 181 ventilator waveforms. Experts identified 21 cases of ‘possible’ RT and 25 cases of ‘definite’ RT. RT evidence was present in 18.8% of waveforms before 2013. Most cases were reported after 2000 (1 before vs. 45 after, P=0.03). Of the RT cases, 54% were initially attributed to other phenomena. Some RT cases identified prior to 2013 were described using different terminology, with the earliest from 1997. Although RT misattribution decreased post-2013, 60% of ‘possible’ RT cases were still missed.
Investigators concluded that RT was identified in pre-2013 studies, but its prevalence increased with low tidal volume ventilation post-2000. Despite recognition in 2013, many cases remained undetected.
Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01303-4
