• Pablo O Rodriguez, Norberto Tiribelli, Sebastián Fredes, Emiliano Gogniat, Gustavo Plotnikow, Fernandez Ceballos Ignacio I Intensive Care Unit, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina., Romina Pratto, Alejandro Raimondi, María Guaymas, Santiago Ilutovich, Eduardo San Román, Matías Madorno, Patricio Maskin, Laurent Brochard, Mariano Setten, and Grupo Argentino de Estudio de Asincronías en la Ventilación Mecánica Study Group.
• Intensive Care Unit, Centro de Educación Médica e Investigaciones Clínicas, Ciudad Autónoma de Buenos Aires, Argentina; Pulmonary Medicine School of Medicine, Centro de Educación Médica e Investigaciones Clínicas, Ciudad Autónoma de Buenos Aires, Argentina; Instituto Universitario, Centro de Educación Médica e Investigaciones Clínicas, Ciudad Autónoma de Buenos Aires, Argentina. Electronic address: prodriguez@cemic.edu.ar.
• Chest. 2021 Jan 1; 159 (1): 186-195.

BackgroundThe prevalence of reverse triggering (RT) in the early phase of ARDS is unknown.Research QuestionDuring early ARDS, what is the proportion of patients affected by RT, what are its potential predictors, and what is its association with clinical outcomes?Study Design And MethodsThis was prospective, multicenter, and observational study. Patients who met the Berlin definition of ARDS with less than 72 h of mechanical ventilation and had not been paralyzed with neuromuscular blockers were screened. A 30-min recording of respiratory signals was obtained from the patients as soon as they were enrolled, and the number of breaths with RT were counted.ResultsOne hundred patients were included. ARDS was mild to moderate in 92% of them. The recordings were obtained after a median of 1 day (interquartile range, 1-2 days) of ventilation. Fifty patients had RT, and most of these events (97%) were not associated with breath stacking. Detecting RT was associated with lower tidal volume (Vt) and less opiate infusion. The presence of RT was not associated with time to discontinuation of mechanical ventilation (subdistribution hazard ratio, 1.03; 95% CI, 0.6-1.77), but it possibly was associated with a reduced hospital mortality (hazard ratio, 0.65; 95% CI, 0.57-0.73).InterpretationFifty percent of patients receiving assist-control ventilation for mild or moderate ARDS, sedated and nonparalyzed, demonstrate RT without breath stacking on the first day of mechanical ventilation. RT may be associated with low VTS and opiate doses.Trial RegistryClinicalTrials.gov; No.: NCT02732041; URL: www.clinicaltrials.gov.Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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