• Isabella Bianchi, Alice Grassi, Tài Pham, Irene Telias, Maddalena Teggia Droghi, Fernando Vieira, Annemijn Jonkman, Laurent Brochard, and Giacomo Bellani.
• Department of Anesthesia and Intensive Care Medicine, Papa Giovanni XXXIII Hospital, Bergamo, Italy; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Clinical-Surgical, diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy. Electronic address: isabellabianchi7@hotmail.it.
• J Crit Care. 2022 Apr 1; 68: 96-103.

PurposeAn inspiratory hold during patient-triggered assisted ventilation potentially allows to measure driving pressure and inspiratory effort. However, muscular activity can make this measurement unreliable. We aim to define the criteria for inspiratory holds reliability during patient-triggered breaths.Material And MethodsFlow, airway and esophageal pressure recordings during patient-triggered breaths from a multicentre observational study (BEARDS, NCT03447288) were evaluated by six independent raters, to determine plateau pressure readability. Features of "readable" and "unreadable" holds were compared. Muscle pressure estimate from the hold was validated against other measures of inspiratory effort.ResultsNinety-two percent of the recordings were consistently judged as readable or unreadable by at least four raters. Plateau measurement showed a high consistency among raters. A short time from airway peak to plateau pressure and a stable and longer plateau characterized readable holds. Unreadable plateaus were associated with higher indexes of inspiratory effort. Muscular pressure computed from the hold showed a strong correlation with independent indexes of inspiratory effort.ConclusionThe definition of objective parameters of plateau reliability during assisted-breath provides the clinician with a tool to target a safer assisted-ventilation and to detect the presence of high inspiratory effort.Copyright © 2021 Elsevier Inc. All rights reserved.

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