Double cycling with breath-stacking during partial support ventilation in ARDS: Just a feature of natural variability?

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dc.article.number19
dc.catalogadorpva
dc.contributor.authorBrito, Roberto
dc.contributor.authorMorais, Caio C. A.
dc.contributor.authorArellano, Daniel H.
dc.contributor.authorGajardo, Abraham I. J.
dc.contributor.authorBruhn, Alejandro
dc.contributor.authorBrochard, L.
dc.contributor.authorAmato, Marcelo B. P.
dc.contributor.authorCornejo, Rodrigo A.
dc.date.accessioned2025-01-14T15:55:43Z
dc.date.available2025-01-14T15:55:43Z
dc.date.issued2025
dc.date.updated2025-01-12T01:04:47Z
dc.description.abstractBackground Double cycling with breath-stacking (DC/BS) during controlled mechanical ventilation is considered potentially injurious, reflecting a high respiratory drive. During partial ventilatory support, its occurrence might be attributable to physiological variability of breathing patterns, reflecting the response of the mode without carrying specific risks. Methods This secondary analysis of a crossover study evaluated DC/BS events in hypoxemic patients resuming spontaneous breathing in cross-over under neurally adjusted ventilatory assist (NAVA), proportional assist ventilation (PAV +), and pressure support ventilation (PSV). DC/BS was defined as two inspiratory cycles with incomplete exhalation. Measurements included electrical impedance signal, airway pressure, esophageal and gastric pressures, and flow. Breathing variability, dynamic compliance (CLdyn), and end-expiratory lung impedance (EELI) were analyzed. Results Twenty patients under assisted breathing, with a median of 9 [5–14] days on mechanical ventilation, were included. DC/BS was attributed to either a single (42%) or two apparent consecutive inspiratory efforts (58%). The median [IQR] incidence of DC/BS was low: 0.6 [0.1–2.6] % in NAVA, 0.0 [0.0–0.4] % in PAV + , and 0.1 [0.0–0.4] % in PSV (p = 0.06). DC/BS events were associated with patient’s coefficient of variability for tidal volume (p = 0.014) and respiratory rate (p = 0.011). DC/BS breaths exhibited higher tidal volume, muscular pressure and regional stretch compared to regular breaths. Post-DC/BS cycles frequently exhibited improved EELI and CLdyn, with no evidence of expiratory muscle activation in 63% of cases. Conclusions DC/BS events during partial ventilatory support were infrequent and linked to breathing variability. Their frequency and physiological effects on lung compliance and EELI resemble spontaneous sighs and may not be considered a priori as harmful.
dc.fechaingreso.objetodigital2025-01-12
dc.format.extent6 páginas
dc.fuente.origenBiomed Central
dc.identifier.citationCritical Care. 2025 Jan 10;29(1):19
dc.identifier.doi10.1186/s13054-025-05260-7
dc.identifier.issn1364-8535
dc.identifier.urihttps://doi.org/10.1186/s13054-025-05260-7
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/89641
dc.information.autorucEscuela de Medicina; Bruhn, Alejandro; 0000-0001-8034-1937; 741
dc.language.isoen
dc.nota.accesocontenido completo
dc.revistaCritical Care
dc.rightsacceso abierto
dc.rights.holderThe Author(s)
dc.rights.licenseAttribution-NonCommercial-NoDerivatives 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subjectDouble cycling
dc.subjectBreath stacking
dc.subjectPartial support ventilation
dc.subjectBreathing variability
dc.subject.ddc610
dc.subject.deweyMedicina y saludes_ES
dc.subject.ods03 Good health and well-being
dc.subject.odspa03 Salud y bienestar
dc.titleDouble cycling with breath-stacking during partial support ventilation in ARDS: Just a feature of natural variability?
dc.typeartículo
dc.volumen29
sipa.codpersvinculados741
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