{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T01:53:50Z","timestamp":1792634030002,"version":"4.5.0"},"reference-count":43,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2022,3,1]],"date-time":"2022-03-01T00:00:00Z","timestamp":1646092800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institute of Health Research","doi-asserted-by":"crossref","award":["PJT-156336"],"award-info":[{"award-number":["PJT-156336"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institute of Health Research","doi-asserted-by":"crossref","award":["PJT-156336"],"award-info":[{"award-number":["PJT-156336"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.atsjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,3,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Reverse triggering dyssynchrony (RT) is a patient\u2013ventilator interaction where a respiratory muscle contraction is triggered by a passive mechanical insufflation. Its impact on diaphragm structure and function is unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u201335 breaths\/min; n\u2009=\u20098) or a more lung-protective strategy (Vt: 6\u20138 ml\/kg; n\u2009=\u200924) 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\u2013time product.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1164\/rccm.202105-1089oc","type":"journal-article","created":{"date-parts":[[2021,12,23]],"date-time":"2021-12-23T13:21:27Z","timestamp":1640265687000},"page":"663-673","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":57,"title":["Impact of Reverse Triggering Dyssynchrony during Lung-Protective Ventilation on Diaphragm Function: An Experimental Model"],"prefix":"10.1093","volume":"205","author":[{"given":"L. Felipe","family":"Damiani","sequence":"first","affiliation":[{"name":"Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Departamento de Ciencias de la Salud, Carrera de Kinesiolog\u00eda, and"},{"name":"Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Cat\u00f3lica de Chile, Santiago, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Doreen","family":"Engelberts","sequence":"additional","affiliation":[{"name":"Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Bastia","sequence":"additional","affiliation":[{"name":"Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Neurointensive Care Unit, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda Ca\u2019 Granda, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kohei","family":"Osada","sequence":"additional","affiliation":[{"name":"Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4504-7094","authenticated-orcid":false,"given":"Bhushan H.","family":"Katira","sequence":"additional","affiliation":[{"name":"Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada"},{"name":"Division of Pediatric Critical Care Medicine, Department of Pediatrics, School of Medicine, Washington University in St. Louis, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gail","family":"Otulakowski","sequence":"additional","affiliation":[{"name":"Translational Medicine Program, The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0990-6701","authenticated-orcid":false,"given":"Ewan C.","family":"Goligher","sequence":"additional","affiliation":[{"name":"Interdepartmental Division of Critical Care Medicine and"},{"name":"Department of Medicine, Division of Respirology, University Health Network, Toronto, Ontario, Canada"},{"name":"Toronto General Hospital Research Institute, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. 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