Reverse Triggering vs Double Triggering in Ventilator Dyssynchrony

Reverse triggering is a type of patient-ventilator dyssynchrony where patient effort is initiated by a ventilator-delivered breath, often seen in heavily sedated patients or those transitioning from sedation. It is diagnosed by recognizing patient effort during or after insufflation, typically observed in waveform alterations like changes in flow or pressure. Reverse triggering can lead to complications such as breath-stacking, which increases the risk of lung injury through excessive tidal volumes or regional lung stress. Management involves strategies like reducing respiratory rate, adjusting sedation, or, in severe cases, using paralysis. While pressure-controlled ventilation may reduce the risk compared to other modes, reverse triggering remains challenging to manage and requires further study to understand its mechanisms and implications. Ongoing research aims to provide insights into this under-recognized phenomenon.
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