{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T22:44:25Z","timestamp":1792190665182,"version":"4.4.0"},"reference-count":42,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,2,15]],"date-time":"2021-02-15T00:00:00Z","timestamp":1613347200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,2,15]],"date-time":"2021-02-15T00:00:00Z","timestamp":1613347200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Keenan Chair in Critical Care and Respiratory failure"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Crit Care"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Reverse triggering (RT) is a dyssynchrony defined by a respiratory muscle contraction following a passive mechanical insufflation. It is potentially harmful for the lung and the diaphragm, but its detection is challenging. Magnitude of effort generated by RT is currently unknown. Our objective was to validate supervised methods for automatic detection of RT using only airway pressure (Paw) and flow. A secondary objective was to describe the magnitude of the efforts generated during RT.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We developed algorithms for detection of RT using Paw and flow waveforms. Experts having Paw, flow and esophageal pressure (Pes) assessed automatic detection accuracy by comparison against visual assessment. Muscular pressure (Pmus) was measured from Pes during RT, triggered breaths and ineffective efforts.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Tracings from 20 hypoxemic patients were used (mean age 65\u2009\u00b1\u200912\u00a0years, 65% male, ICU survival 75%). RT was present in 24% of the breaths ranging from 0 (patients paralyzed or in pressure support ventilation) to 93.3%. Automatic detection accuracy was 95.5%: sensitivity 83.1%, specificity 99.4%, positive predictive value 97.6%, negative predictive value 95.0% and kappa index of 0.87. Pmus of RT ranged from 1.3 to 36.8 cmH<jats:sub>2<\/jats:sub>0, with a median of 8.7 cmH<jats:sub>2<\/jats:sub>0. RT with breath stacking had the highest levels of Pmus, and RTs with no breath stacking were of similar magnitude than pressure support breaths.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>An automated detection tool using airway pressure and flow can diagnose reverse triggering with excellent accuracy. RT generates a median Pmus of 9 cmH<jats:sub>2<\/jats:sub>O with important variability between and within patients.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p>BEARDS, NCT03447288.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13054-020-03387-3","type":"journal-article","created":{"date-parts":[[2021,2,17]],"date-time":"2021-02-17T14:16:29Z","timestamp":1613571389000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":57,"title":["Automated detection and quantification of reverse triggering effort under mechanical ventilation"],"prefix":"10.1186","volume":"25","clinical-trial-number":[{"clinical-trial-number":"nct03447288","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4373-0711","authenticated-orcid":false,"given":"T\u00e0i","family":"Pham","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaume","family":"Montanya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Telias","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4887-8686","authenticated-orcid":false,"given":"Thomas","family":"Piraino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rudys","family":"Magrans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R\u00e9mi","family":"Coudroy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8338-0488","authenticated-orcid":false,"given":"L. 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All patients or their surrogate decision-makers provided informed consent to participate in the study.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Dr. Telias reports personal fees from Covidien, Argentina, and\u00a0MBMed SA, Argentina, Dr. Madorno is the partner and manager of MBMed S.A. and had received grants for development of medical technology from the Argentinean Ministry of Science and Technology outside of the submitted work. Thomas Piraino reports Speaker fees and consulting from Drager, Philips and Fisher& Paykel. Lluis Blanch has been named in a provisional European patent application number EP19383116 owned by Corporaci\u00f3 Sanit\u00e0ria Parc Taul\u00ed: \u201cA device and method for respiratory monitoring in mechanically ventilated patients.\u201d Lluis Blanch is the inventor of a US patent owned by Corporaci\u00f3 Sanit\u00e0ria Parc Taul\u00ed: \u201cMethod and system for managed related patient parameters provided by a monitoring device,\u201d US Patent No. 12\/538,940. Jaume Montanya and Lluis Blanch own stock options of BetterCare S.L., a research and development spinoff of Corporaci\u00f3 Sanit\u00e0ria Parc Taul\u00ed. Ricard Mellado\u00a0Artigas received speaker fees from Medtronic. Laurent Brochard reports research grants from Covidien Medtronic, equipment support from Philips, equipment support from Sentec, equipment support from Air Liquide, grants and equipment support from Fisher Paykel, grants from General Electric, outside the submitted work.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"60"}}