Identifying Potential Ventilator Auto-Triggering Among Organ Procurement Organization Referrals

Abstract

Context:

Ventilator auto-trigger is the delivery of an assisted mechanical ventilated breath over the set ventilator frequency in the absence of a spontaneous inspiratory effort and can be caused by inappropriate ventilator trigger sensitivity. Ventilator auto-trigger can be misinterpreted as a spontaneous breath and has the potential to delay or prevent brain death testing and confuse health-care professionals and/or patient families.

Objective:

To determine the frequency of organ donor referrals from 1 Organ Procurement Organization (OPO) that could benefit from an algorithm designed to assist organ recovery coordinators to identify and correct ventilator auto-triggering.

Design:

This retrospective analysis evaluated documentation of organ donor referrals from 1 OPO in central Texas during the 2013 calendar year that resulted in the withdrawal of care by the patient’s family and the recovery of organs.

Main Outcome Measures:

The frequency of referrals that presented with absent brain stem reflexes except for additional respirations over the set ventilator rate was determined to assess for the need of the proposed algorithm.

Results:

Documentation of 672 organ procurement organization referrals was evaluated. Documentation from 42 referrals that resulted in the withdrawal of care and 21 referrals that resulted in the recovery of organs were identified with absent brain stem reflexes except for spontaneous respirations on the mechanical ventilator. As a result, an algorithm designed to identify and correct ventilator auto-trigger could have been used 63 times during the 2013 calendar year.

Keywords

ventilator auto-trigger ventilator self-cycle ventilator asynchrony brain death determination

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References

Practice parameters for determining brain death in adults (summary statement). The Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 1995;45(5):1012–1014.

Wijdicks

Varelas

Gronseth

Greer

. Evidence-based guideline update: determining brain death in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2010;74(23):1911–1918. doi:10.1212/WNL0b013e3181e242a8.

Dodd-Sullivan

Quirin

Newhart

. Ventilator autotriggering: a caution in brain death diagnosis. Prog Transplant. 2011;21(2):152–155.

Wijdicks

. Brain death guidelines explained. Semin Neurol. 2015;35(2):105–115. doi:10.1055/s-0035-1547532.

Nilsestuen

Hargett

. Using ventilator graphics to identify patient-ventilator asynchrony. Respir Care. 2005;50(2):202–234.

de Wit

. Monitoring of patient-ventilator interaction at the bedside. Respir Care. 2011;56(1):61–72. doi:10.4187/respcare.01077.

Arbour

. Cardiogenic oscillation and ventilator autotriggering in brain-dead patients: a case series. Am J Crit Care. 2009;18(5):496,488–495. doi:10.4037/ajcc2009690.

Arbour

. Confounding factors in brain death: cardiogenic ventilator autotriggering and implications for organ transplantation. Intensive Crit Care Nurs. 2012;28(6):321–328. doi:10.1016/j.iccn.2012.03.003.

McGee

Mailloux

. Ventilator autocycling and delayed recognition of brain death. Neurocrit Care. 2011;14(2):267–271. doi:10.1007/s12028-010-9491-6.

10.

Willatts

Drummond

. Brainstem death and ventilator trigger settings. Anaesthesia. 2000;55(7):676–677.

11.

Bohatyrewicz

Walecka

Bohatyrewicz

. Unusual movements, “spontaneous” breathing, and unclear cerebral vessels sonography in a brain-dead patient: a case report. Transplant Proc. 2007;39(9):2707–2708.

12.

Wijdicks

Manno

Holets

. Ventilator self-cycling may falsely suggest patient effort during brain death determination. Neurology. 2005;65(5):774.

13.

Colombo

Cammarota

Alemani

. Efficacy of ventilator waveforms observation in detecting patient-ventilator asynchrony. Crit Care Med. 2011;39(11):2452–2457. doi:10.1097/CCM.0b013e318225753c.

14.

Chatburn

. Fundamentals of Mechanical Ventilation: A Short Course in the Theory and Application of Mechanical Ventilators. Cleveland Heights, OH: Mandu Press Ltd; 2003:29–31.

15.

Holt

. Cardiogenic triggering observed in a patient with acute respiratory distress syndrome. Respir Care. 2001;46(10):1054–1055.

16.

Imanaka

Nishimura

Takeuchi

Kimball

Yahagi

Kumon

. Autotriggering caused by cardiogenic oscillation during flow-triggered mechanical ventilation. Crit Care Med. 2000;28(2):402–407.

17.

Hocker

Schumacher

Mandrekar

Wijdicks

. Testing confounder in brain death determination: a new simulation model. Neurocrit Care. 2015;23(3):401–408.

18.

Cairo

. Pilbeam’s Mechanical Ventilation: Physiological and Clinical Applications. 5th Ed. St. Louis, MO: Mosby Inc.; 2012:368.