Affiliations: Department of Anesthesiology and Division of Pediatric Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Note:  Address for correspondence: Katherine C. Clement, University of North Carolina at Chapel Hill, Department of Anesthesiology and Division of Pediatric Critical Care Medicine, 214 MacNider, CB 7221, Chapel Hill, NC 27599-7221, USA. Tel.: +1 919 966 7495; Fax: +1 919 966 6164; E-mail: [email protected]
Abstract: Allowing spontaneous respiration during mechanical ventilation requires that the ventilator system can interpret a trigger signal from the patient and then deliver a synchronous breath. The majority of current ventilators are triggered by preset changes in pressure or flow detected in the system as a patient is initiating a breath. However, other triggers such as chest wall motion, waveform alteration, and diaphragmatic electromyograms have also been utilized. The time between initiation of a breath by a patient and delivery of a breath by the ventilator is known as trigger delay. Most trigger delay is inherent in the mechanics of the patient-ventilator interaction. However, recent advances in technology have captured a neural signal from the diaphragm to trigger the ventilator to deliver a breath, reducing trigger delay. Understanding trigger delay is important as it may lead to increased work of breathing and patient-ventilator asynchrony. Types of asynchrony related to the triggering phase are ineffective triggering, double triggering, and autotriggering. The presence of asynchrony has been shown to have deleterious effects on patients, including duration of mechanical ventilation and increased length of hospital stay. Recognizing asynchrony and understanding how to manipulate the trigger variable will reduce adverse effects on patients.