Browsing by Author "Tiribelli, Norberto"

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    Automatic detection of reverse‑triggering related asynchronies during mechanical ventilation in ARDS patients using flow and pressure signals
    (2019) Rodríguez, Pablo Oscar; Tiribelli, Norberto; Gogniat, Emiliano; Plotnikow, Gustavo A.; Fredes, Sebastián; Fernández Ceballos, Ignacio; Pratto, Romina A.; Madorno, Matías; Ilutovich, Santiago; San Román, Eduardo; Bonelli, Ignacio; Guaymas, María; Raimondi, Alejandro C.; Maskin, Luis Patricio; Setten, Mariano
    "Asynchrony due to reverse-triggering (RT) may appear in ARDS patients. The objective of this study is to validate an algo-rithm developed to detect these alterations in patient–ventilator interaction. We developed an algorithm that uses flow and airway pressure signals to classify breaths as normal, RT with or without breath stacking (BS) and patient initiated double-triggering (DT). The diagnostic performance of the algorithm was validated using two datasets of breaths, that are classified as stated above. The first dataset classification was based on visual inspection of esophageal pressure (Pes) signal from 699 breaths recorded from 11 ARDS patients. The other classification was obtained by vote of a group of 7 experts (2 physicians and 5 respiratory therapists, who were trained in ICU), who evaluated 1881 breaths gathered from recordings from 99 sub-jects. Experts used airway pressure and flow signals for breaths classification. The RT with or without BS represented 19% and 37% of breaths in Pes dataset while their frequency in the expert’s dataset were 3% and 12%, respectively. The DT was very infrequent in both datasets. Algorithm classification accuracy was 0.92 (95% CI 0.89–0.94, P < 0.001) and 0.96 (95% CI 0.95–0.97, P < 0.001), in comparison with Pes and experts’ opinion. Kappa statistics were 0.86 and 0.84, respectively. The algorithm precision, sensitivity and specificity for individual asynchronies were excellent. The algorithm yields an excellent accuracy for detecting clinically relevant asynchronies related to RT."
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    Prevalence of reverse triggering in early ARDS: results from a multicenter observational study
    (2021-01) Rodríguez, Pablo Oscar; Tiribelli, Norberto; Fredes, Sebastián; Gogniat, Emiliano; Plotnikow, Gustavo A.; Fernández Ceballos, Ignacio; Pratto, Romina A.; Raimondi, Alejandro C.; Guaymas, María; Ilutovich, Santiago; San Román, Eduardo; Madorno, Matías; Maskin, Luis Patricio; Brochard, Laurent; Setten, Mariano
    "Background: The prevalence of reverse triggering (RT) in the early phase of ARDS is unknown. Research question: During early ARDS, what is the proportion of patients affected by RT, what are its potential predictors, and what is its association with clinical outcomes? Study design and methods: This was prospective, multicenter, and observational study. Patients who met the Berlin definition of ARDS with less than 72 h of mechanical ventilation and had not been paralyzed with neuromuscular blockers were screened. A 30-min recording of respiratory signals was obtained from the patients as soon as they were enrolled, and the number of breaths with RT were counted."