• Rudys Magrans, Francini Ferreira, Leonardo Sarlabous, Josefina López-Aguilar, Gemma Gomà, Sol Fernandez-Gonzalo, Guillem Navarra-Ventura, Rafael Fernández, Jaume Montanyà, Robert Kacmarek, Montserrat Rué, Carles Forné, Lluís Blanch, Candelaria de Haro, José Aquino-Esperanza, and ASYNICU group.
• Better Care, S. L., Sabadell, Spain.
• Crit. Care Med. 2022 Jul 1; 50 (7): e619e629e619-e629.

ObjectivesTo 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.DesignRegistry-based, real-world study.BackgroundAsynchronies during invasive mechanical ventilation can occur as isolated events or in clusters and might be related to clinical outcomes.SubjectsAdults requiring mechanical ventilation greater than 24 hours for whom greater than or equal to 70% of ventilator waveforms were available.InterventionsWe 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 ResultsWe 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).ConclusionsClusters 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.Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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