Impact of Reverse Triggering Dyssynchrony during Lung-Protective Ventilation on Diaphragm Function An Experimental Model

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dc.contributor.authorDamiani, L. Felipe
dc.contributor.authorEngelberts, Doreen
dc.contributor.authorBastia, Luca
dc.contributor.authorOsada, Kohei
dc.contributor.authorKatira, Bhushan H.
dc.contributor.authorOtulakowski, Gail
dc.contributor.authorGoligher, Ewan C.
dc.contributor.authorReid, W. Darlene
dc.contributor.authorDubo, Sebastian
dc.contributor.authorBruhn, Alejandro
dc.contributor.authorPost, Martin
dc.contributor.authorKavanagh, Brian P.
dc.contributor.authorBrochard, Laurent J.
dc.date.accessioned2025-01-20T21:10:53Z
dc.date.available2025-01-20T21:10:53Z
dc.date.issued2022
dc.description.abstractRationale: Reverse triggering dyssynchrony (RT) is a patient-ventilator interaction where a respiratory muscle contraction is triggered by a passive mechanical insufflation. Its impact on diaphragm structure and function is unknown.
dc.description.abstractObjectives: To establish an animal model of RT with lung injury receiving lung-protective ventilation and to assess its impact on the structure and function of the diaphragm.
dc.description.abstractMethods: Lung injury was induced by surfactant depletion and high-stress ventilation in 32 ventilated pigs. Animals were allocated to receive passive mechanical ventilation (VT: 10 ml/kg; respiratory rate [RR]: 30-35 breaths/min; n = 8) or a more lungprotective strategy (VT: 6-8 ml/kg; n = 24) with adjustments in RR to facilitate the occurrence of RT for 3 hours. Diaphragm function (transdiaphragmatic pressure [Pdi] during phrenic nerve stimulation [force/frequency curve]) and structure (biopsies) were assessed. The impact of RT on diaphragm function was analyzed according to the breathing effort assessed by the pressure-time product.
dc.description.abstractMeasurements and Main Results: Compared with passive ventilation, the protective ventilation group with RT received significantly lower VT (7 vs. 10 ml/kg) and higher RR (45 vs. 31 breaths/min). An entrainment pattern of 1:1 was the most frequently occurring in 83% of the animals. Breathing effort induced by RT was highly variable across animals. RT with the lowest tercile of breathing effort was associated with 23% higher twitch Pdi compared with passive ventilation, whereas RT with high breathing effort was associated with a 10% lower twitch Pdi and a higher proportion of abnormal muscle fibers.
dc.description.abstractConclusions: In a reproducible animal model of RT with variable levels of breathing effort and entrainment patterns, RT with high effort is associated with impaired diaphragm function, whereas RT with low effort is associated with preserved diaphragm force.
dc.fuente.origenWOS
dc.identifier.doi10.1164/rccm.202105-1089OC
dc.identifier.eissn1535-4970
dc.identifier.issn1073-449X
dc.identifier.urihttps://doi.org/10.1164/rccm.202105-1089OC
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/93598
dc.identifier.wosidWOS:000771731700015
dc.issue.numero6
dc.language.isoen
dc.pagina.final673
dc.pagina.inicio663
dc.revistaAmerican journal of respiratory and critical care medicine
dc.rightsacceso restringido
dc.subjectreverse triggering
dc.subjectdiaphragm dysfunction
dc.subjectmyotrauma
dc.subject.ods03 Good Health and Well-being
dc.subject.odspa03 Salud y bienestar
dc.titleImpact of Reverse Triggering Dyssynchrony during Lung-Protective Ventilation on Diaphragm Function An Experimental Model
dc.typeartículo
dc.volumen205
sipa.indexWOS
sipa.trazabilidadWOS;2025-01-12
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