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A direct causative relationship between Patient\u2013ventilator asynchrony and adverse clinical outcome have yet to be demonstrated. It is hypothesized that during trigger errors excessive pleural pressure swings are generated, contributing to increased work-of-breathing and self-inflicted lung injury. The objective of this study was to determine the additional work-of-breathing and pleural pressure swings caused by trigger errors in mechanically ventilated children.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Prospective observational study in a tertiary paediatric intensive care unit in an university hospital. Patients ventilated\u2009&gt;\u200924\u00a0h and\u2009&lt;\u200918\u00a0years old were studied. Patients underwent a 5-min recording of the ventilator flow\u2013time, pressure\u2013time and oesophageal pressure\u2013time scalar. Pressure\u2013time\u2013product calculations were made as a proxy for work-of-breathing. Oesophageal pressure swings, as a surrogate for pleural pressure swings, during trigger errors were determined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Nine-hundred-and-fifty-nine trigger errors in 28 patients were identified. The additional work-of-breathing caused by trigger errors showed great variability among patients. The more asynchronous breaths were present the higher the work-of-breathing of these breaths. A higher spontaneous breath rate led to a lower amount of trigger errors. Patient\u2013ventilator asynchrony was not associated with prolonged duration of mechanical ventilation or paediatric intensive care stay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The additional work-of-breathing caused by trigger errors in ventilated children can take up to 30\u201340% of the total work-of-breathing. Trigger errors were less common in patients breathing spontaneously and those able to generate higher pressure\u2013time\u2013product and pressure swings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>Not applicable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12931-020-01561-3","type":"journal-article","created":{"date-parts":[[2020,11,10]],"date-time":"2020-11-10T07:25:09Z","timestamp":1604993109000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Additional work of breathing from trigger errors in mechanically ventilated children"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8607-6134","authenticated-orcid":false,"given":"Robert G. 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