2026-04-14T04:42:26Zhttps://recercat.cat/oai/request

oai:recercat.cat:2072/4776932025-07-29T23:15:43Zcom_2072_98col_2072_378192

The Effect of Clusters of Double Triggering and Ineffective Efforts in Critically Ill Patients Magrans, Rudys Ferreira, Francini Sarlabous, Leonardo López-Aguilar, Josefina Gomà, Gemma Fernandez-Gonzalo, Sol Navarra-Ventura, Guillem Fernández, Rafael Montanyà, Jaume Kacmarek, Robert Rué, Montserrat Forne, Carles Blanch, Lluís De Haro, Candelaria Aquino Esperanza, Jose Clusters Competing risk Double triggering Ineffective inspiratory efforts Patient-ventilator interactions Dr. Magrans is supported by a Torres Quevedo contract (PTQ2018-010120) from the Agencia Española de Investigacion, Spain. Dr. Sarlabous is supported by Pla Estratègic de Recerca i Innovació en Salut program from the Health Department of Generalitat de Catalunya, Spain. Dr. Blanch is inventor of a U.S. patent owned by the Corporació Sanitària Parc Taulí: "Method and system for managing related patient parameters provided by a monitoring device," U.S. Patent No. 12/538,940. Drs. Montanyà and Blanch own stock options in BetterCare S.L., a research and development spinoff of Corporació Sanitària Parc Taulí (Spain). The remaining authors have disclosed that they do not have any potential conflicts of interest. Supported, in part, by projects PI16/01606, integrated in the Plan Nacional de R+D+I and cofunded by the Instituto de Salud Carlos III-Subdirección General de Evaluación y el Fondo Europeo de Desarrollo Regional. RTC-2017-6193-1 (AEI/FEDER UE). Centro de Investigaciones Biomedicas en Red Enfermedades Respiratorias. OBJECTIVES: To characterize clusters of double triggering and ineffective inspiratory efforts throughout mechanical ventilation and investigate their associations with mortality and duration of ICU stay and mechanical ventilation. DESIGN: Registry-based, real-world study. Background: Asynchronies during invasive mechanical ventilation can occur as isolated events or in clusters and might be related to clinical outcomes. Subjects: Adults requiring mechanical ventilation greater than 24 hours for whom greater than or equal to 70% of ventilator waveforms were available. INTERVENTIONS: We identified clusters of double triggering and ineffective inspiratory efforts and determined their power and duration. We used Fine-Gray's competing risk model to analyze their effects on mortality and generalized linear models to analyze their effects on duration of mechanical ventilation and ICU stay. MEASUREMENTS AND MAIN RESULTS: We analyzed 58,625,796 breaths from 180 patients. All patients had clusters (mean/d, 8.2 [5.4-10.6]; mean power, 54.5 [29.6-111.4]; mean duration, 20.3 min [12.2-34.9 min]). Clusters were less frequent during the first 48 hours (5.5 [2.5-10] vs 7.6 [4.4-9.9] in the remaining period [p = 0.027]). Total number of clusters/d was positively associated with the probability of being discharged alive considering the total period of mechanical ventilation (p = 0.001). Power and duration were similar in the two periods. Power was associated with the probability of being discharged dead (p = 0.03), longer mechanical ventilation (p < 0.001), and longer ICU stay (p = 0.035); cluster duration was associated with longer ICU stay (p = 0.027). CONCLUSIONS: Clusters of double triggering and ineffective inspiratory efforts are common. Although higher numbers of clusters might indicate better chances of survival, clusters with greater power and duration indicate a risk of worse clinical outcomes. 2022 Article Ministerio de Economía y Competitividad PI16/01606 Agencia Estatal de Investigación RTC-2017-6193-1 Agencia Estatal de Investigación PTQ2018-010120 Critical Care Medicine ; Vol. 50 Núm. 7 (january 2022), p. e619-e629 open access Aquest material està protegit per drets d'autor i/o drets afins. Podeu utilitzar aquest material en funció del que permet la legislació de drets d'autor i drets afins d'aplicació al vostre cas. Per a d'altres usos heu d'obtenir permís del(s) titular(s) de drets. https://rightsstatements.org/vocab/InC/1.0/