Overbeek, L.E. (Linde) (2018) Reverse Triggering, a frequently unrecognised type of asynchrony made visible: a study of the validation of theNeuroSync software. thesis, Medicine.
Full text available on request.Abstract
Introduction: The bedside clinical detection of patient-ventilator asynchrony (PVA) is limited and recently several automated detection methods have emerged as an alternative for the detection. This is important, because PVA has been associated with higher mortality. Reverse triggering (RT) is a type of asynchrony that has recently been discovered and that describes the muscular efforts of the patient which are triggered by the mechanical ventilator. It occurs often in a cyclic manner with a specific pattern. NeuroSync software (an automated method based on electrical activity of the diaphragm) was developed to automatically detect asynchronies. This study aims to explore the different entrainment patterns associated to RT, to validate the NeuroSync software as an automated method to detect RT and determine the prevalence and clinical variables associated to RT in patients with mechanical ventilation. Methods: a prospective observational clinical study was conducted. Adults patients admitted to the ICU on their first day of mechanical ventilation in the St. Michael’s Hospital, Toronto, Canada were included. The time delay between the start of the inspiration by the mechanical ventilator and start of inspiratory effort by the patient, assessed by EAdi, was automatically analysed by NeuroSync for each breath (Eadi delay). Eadi delay data provided by NeuroSync was used to automatically determine RT. In parallel, flow-, pressure-, volume- and EAdi curves were visually analysed by 3 healthcare professionals to detect RT, and this analysis was used as the reference method. This method was also used to map the different entrainment patterns. The prevalence of RT was determined using NeuroSync. Lastly, we divided the patients in 2 groups according to whether they had <10% or >10% of their respirations with RT, to compare different clinical parameters and outcomes. Results: 10 patients were included for the analysis of the diagnostic accuracy of NeuroSync. The best Eadi delay cutoff point was 0.016 seconds, which presented an accuracy of 0.9, sensitivity of 0.79, and a specificity of 0.95. To determine prevalence a total of 28 patients were analysed. Using the new cutoff point, 10 out of 28 patients (35,7%) presented with >10% of respirations with RT. RT entrainment patterns were observed in patients ranging from 1:1 to 1:4, 1:1 being the most frequent and stable one. Comparing patients with <10% and >10% of respirations with RT there were no significant differences in clinical parameters or outcomes observed. Conclusion: NeuroSync presents a good diagnostic accuracy for the detection of RT and its utilisation demonstrates that RT is frequent in patients with mechanical ventilation. RT can present itself in different entrainment patterns, between which a patient can easily switch. RT was not associated to any clinical variable or outcome.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty supervisor: and Hom, drs. H.W. and Nephrologist-Intensivist, Medisch Spectrum Twente |
| Supervisor name: | Second supervisor: and Bruhn Cruz, dr. A. Chief Department Intensive Care |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:06 |
| Last Modified: | 25 Jun 2020 11:06 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2549 |
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