Detecting ineffective triggering in the expiratory phase in mechanically ventilated patients based on airway flow and pressure deflection: Feasibility of using a computer algorithm

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Abstract

OBJECTIVE: Ineffective triggering (IT) is the most common manifestation of patient-ventilator asynchrony in mechanically ventilated patients. IT in the expiratory phase (ITE) accounts for the majority of IT and is associated with characteristic features of flow and airway pressure deflection, caused by ineffective effort from the patient. The purpose of this study was to quantify the characteristics of flow and airway pressure deflections of ITE and, using a computerized algorithm, to evaluate their usefulness in the detection of ITEs. DESIGN: Prospective, clinical study. SETTING: Medical intensive care unit in a 1,000-bed university hospital. PATIENTS: A total of 14 mechanically ventilated adult patients with patient-ventilator asynchrony. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We analyzed 5,899 breaths and found that 1,831 were ITEs. The average values for maximum flow deflection (Fdef) and maximum airway pressure deflection (Pdef) in ITEs were 13.94 ± 8.0 L/min and 1.91 ± 0.97 cm H2O. With a starting value of 0.1 L/min for Fdef and 0.01 cm H2O for Pdef, the area under the receiver operating characteristics curve of Fdef and Pdef for the detection of ITEs was 0.98 and 0.97, respectively. Sensitivity and specificity for the detection of ITEs were 91.5% and 96.2% for Fdef, respectively, for a cutoff value of 5.45 L/min, and 93.3% and 92.9% for Pdef, for a cutoff value of 0.45 cm H2O. CONCLUSION: We conclude that accurately detecting and quantifying ITEs is feasible using a computerized algorithm based on Fdef and Pdef. Such a computerized estimation of patient-ventilator interaction might be helpful for adjusting ventilator settings in an intensive care unit.

Original languageEnglish
Pages (from-to)455-461
Number of pages7
JournalCritical Care Medicine
Volume36
Issue number2
DOIs
Publication statusPublished - 2008 Jan 1

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Pressure
Mechanical Ventilators
Intensive Care Units
ROC Curve
Prospective Studies
Sensitivity and Specificity

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

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title = "Detecting ineffective triggering in the expiratory phase in mechanically ventilated patients based on airway flow and pressure deflection: Feasibility of using a computer algorithm",
abstract = "OBJECTIVE: Ineffective triggering (IT) is the most common manifestation of patient-ventilator asynchrony in mechanically ventilated patients. IT in the expiratory phase (ITE) accounts for the majority of IT and is associated with characteristic features of flow and airway pressure deflection, caused by ineffective effort from the patient. The purpose of this study was to quantify the characteristics of flow and airway pressure deflections of ITE and, using a computerized algorithm, to evaluate their usefulness in the detection of ITEs. DESIGN: Prospective, clinical study. SETTING: Medical intensive care unit in a 1,000-bed university hospital. PATIENTS: A total of 14 mechanically ventilated adult patients with patient-ventilator asynchrony. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We analyzed 5,899 breaths and found that 1,831 were ITEs. The average values for maximum flow deflection (Fdef) and maximum airway pressure deflection (Pdef) in ITEs were 13.94 ± 8.0 L/min and 1.91 ± 0.97 cm H2O. With a starting value of 0.1 L/min for Fdef and 0.01 cm H2O for Pdef, the area under the receiver operating characteristics curve of Fdef and Pdef for the detection of ITEs was 0.98 and 0.97, respectively. Sensitivity and specificity for the detection of ITEs were 91.5{\%} and 96.2{\%} for Fdef, respectively, for a cutoff value of 5.45 L/min, and 93.3{\%} and 92.9{\%} for Pdef, for a cutoff value of 0.45 cm H2O. CONCLUSION: We conclude that accurately detecting and quantifying ITEs is feasible using a computerized algorithm based on Fdef and Pdef. Such a computerized estimation of patient-ventilator interaction might be helpful for adjusting ventilator settings in an intensive care unit.",
author = "Chang-Wen Chen and Wei-Chieh Lin and Chin-Hsin Hsu and Kuo-Sheng Cheng and Lo, {Chien Shun}",
year = "2008",
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T1 - Detecting ineffective triggering in the expiratory phase in mechanically ventilated patients based on airway flow and pressure deflection

T2 - Feasibility of using a computer algorithm

AU - Chen, Chang-Wen

AU - Lin, Wei-Chieh

AU - Hsu, Chin-Hsin

AU - Cheng, Kuo-Sheng

AU - Lo, Chien Shun

PY - 2008/1/1

Y1 - 2008/1/1

N2 - OBJECTIVE: Ineffective triggering (IT) is the most common manifestation of patient-ventilator asynchrony in mechanically ventilated patients. IT in the expiratory phase (ITE) accounts for the majority of IT and is associated with characteristic features of flow and airway pressure deflection, caused by ineffective effort from the patient. The purpose of this study was to quantify the characteristics of flow and airway pressure deflections of ITE and, using a computerized algorithm, to evaluate their usefulness in the detection of ITEs. DESIGN: Prospective, clinical study. SETTING: Medical intensive care unit in a 1,000-bed university hospital. PATIENTS: A total of 14 mechanically ventilated adult patients with patient-ventilator asynchrony. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We analyzed 5,899 breaths and found that 1,831 were ITEs. The average values for maximum flow deflection (Fdef) and maximum airway pressure deflection (Pdef) in ITEs were 13.94 ± 8.0 L/min and 1.91 ± 0.97 cm H2O. With a starting value of 0.1 L/min for Fdef and 0.01 cm H2O for Pdef, the area under the receiver operating characteristics curve of Fdef and Pdef for the detection of ITEs was 0.98 and 0.97, respectively. Sensitivity and specificity for the detection of ITEs were 91.5% and 96.2% for Fdef, respectively, for a cutoff value of 5.45 L/min, and 93.3% and 92.9% for Pdef, for a cutoff value of 0.45 cm H2O. CONCLUSION: We conclude that accurately detecting and quantifying ITEs is feasible using a computerized algorithm based on Fdef and Pdef. Such a computerized estimation of patient-ventilator interaction might be helpful for adjusting ventilator settings in an intensive care unit.

AB - OBJECTIVE: Ineffective triggering (IT) is the most common manifestation of patient-ventilator asynchrony in mechanically ventilated patients. IT in the expiratory phase (ITE) accounts for the majority of IT and is associated with characteristic features of flow and airway pressure deflection, caused by ineffective effort from the patient. The purpose of this study was to quantify the characteristics of flow and airway pressure deflections of ITE and, using a computerized algorithm, to evaluate their usefulness in the detection of ITEs. DESIGN: Prospective, clinical study. SETTING: Medical intensive care unit in a 1,000-bed university hospital. PATIENTS: A total of 14 mechanically ventilated adult patients with patient-ventilator asynchrony. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We analyzed 5,899 breaths and found that 1,831 were ITEs. The average values for maximum flow deflection (Fdef) and maximum airway pressure deflection (Pdef) in ITEs were 13.94 ± 8.0 L/min and 1.91 ± 0.97 cm H2O. With a starting value of 0.1 L/min for Fdef and 0.01 cm H2O for Pdef, the area under the receiver operating characteristics curve of Fdef and Pdef for the detection of ITEs was 0.98 and 0.97, respectively. Sensitivity and specificity for the detection of ITEs were 91.5% and 96.2% for Fdef, respectively, for a cutoff value of 5.45 L/min, and 93.3% and 92.9% for Pdef, for a cutoff value of 0.45 cm H2O. CONCLUSION: We conclude that accurately detecting and quantifying ITEs is feasible using a computerized algorithm based on Fdef and Pdef. Such a computerized estimation of patient-ventilator interaction might be helpful for adjusting ventilator settings in an intensive care unit.

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