Cardiogenic Oscillation and Ventilator Autotriggering in Brain Death: Implications for Organ Donation.

2.50
Hdl Handle:
http://hdl.handle.net/10755/157197
Category:
Abstract
Type:
Presentation
Title:
Cardiogenic Oscillation and Ventilator Autotriggering in Brain Death: Implications for Organ Donation.
Author(s):
Arbour, Richard B.
Author Details:
Richard B. Arbour, RN,CCRN,CCNS,CNRN, Albert Einstein Healthcare Network, Philadelphia, Pennsylvania, USA, email: richnrs@aol.com
Abstract:
PURPOSE: To determine incidence of cardiogenic oscillation and ventilator autotriggering in a prospective case series of brain-dead patients in a large tertiary care referral center. Secondary purpose was to analyze impact on length of stay in the intensive care unit (ICU) and related financial and clinical implications as well as timing of brain-death determination and organ recovery for transplantation. BACKGROUND/SIGNIFICANCE:Ventilator autotriggering occurs in brain death from interaction among a hyperdynamic cardiovascular state and compliant lung tissue causing gas movement in the patient-ventilator system and cardiogenic oscillations in airway pressure and flow waveforms. When cardiogenic oscillations exceed ventilator trigger sensitivities, ventilator breaths are triggered and misinterpreted as intrinsic respiratory drive delaying brain death determination, increasing ICU days and limiting transplantable organs.

METHOD: A prospective series of 26 patients following catastrophic brain injury, loss of neurological function, and apnea. Four of 26 patients (15%) had measured respiratory rate above ventilator set rate. Reexamination confirmed loss of neurological function and respiratory drive. Ventilator waveform analysis revealed oscillations in pressure and/or flow waveforms matching the cardiac cycle and exceeding ventilator trigger sensitivities. Collaborative practice optimized ventilator trigger mode and sensitivity, eliminating autotriggering. Downloading data from the Servo-I ventilator enabled retrospective analysis of waveform data in context with neurological assessment findings.

RESULTS: Cardiogenic autotriggering was confirmed in 15% of patients in this series. Cardiogenic flow deflections measured 1.5 to 12.0 L/min. Cardiogenic pressure deflections measured 1 to 9 cm H2O. Hyperdynamic cardiovascular states with elevated blood pressure and high stroke volume was strongly associated with greater amplitude of cardiogenic waveform deflections and likelihood of autotriggering in the absence of intrinsic respiratory drive. Autotriggering ended instantly when flow and pressure trigger sensitivities were increased beyond cardiogenic waveform amplitudes. This optimized timing of brain death protocols, decreased ICU length of stay, and increased organ availability for transplantation.

CONCLUSIONS: Cardiogenic autotriggering may be far more common than is realized and may significantly delay determination of brain death, increase family stress, and restrict availability of donor organs. Collaborative practice with scrutiny of neurological status and patient-ventilator interaction makes possible early recognition of autotriggering. Recognition and titration of ventilator triggering facilitates brain death determination, minimizes the ICU experience for families, and increases donor organ availability.

Repository Posting Date:
26-Oct-2011
Date of Publication:
26-Oct-2011
Citation:
2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866
Conference Date:
2010
Conference Name:
National Teaching Institute and Critical Care Exposition
Conference Host:
American Association of Critical-Care Nurses
Conference Location:
Washington, D.C., USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_GB
dc.typePresentationen_GB
dc.titleCardiogenic Oscillation and Ventilator Autotriggering in Brain Death: Implications for Organ Donation.en_GB
dc.contributor.authorArbour, Richard B.en_GB
dc.author.detailsRichard B. Arbour, RN,CCRN,CCNS,CNRN, Albert Einstein Healthcare Network, Philadelphia, Pennsylvania, USA, email: richnrs@aol.comen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157197-
dc.description.abstractPURPOSE: To determine incidence of cardiogenic oscillation and ventilator autotriggering in a prospective case series of brain-dead patients in a large tertiary care referral center. Secondary purpose was to analyze impact on length of stay in the intensive care unit (ICU) and related financial and clinical implications as well as timing of brain-death determination and organ recovery for transplantation. BACKGROUND/SIGNIFICANCE:Ventilator autotriggering occurs in brain death from interaction among a hyperdynamic cardiovascular state and compliant lung tissue causing gas movement in the patient-ventilator system and cardiogenic oscillations in airway pressure and flow waveforms. When cardiogenic oscillations exceed ventilator trigger sensitivities, ventilator breaths are triggered and misinterpreted as intrinsic respiratory drive delaying brain death determination, increasing ICU days and limiting transplantable organs.</p><p>METHOD: A prospective series of 26 patients following catastrophic brain injury, loss of neurological function, and apnea. Four of 26 patients (15%) had measured respiratory rate above ventilator set rate. Reexamination confirmed loss of neurological function and respiratory drive. Ventilator waveform analysis revealed oscillations in pressure and/or flow waveforms matching the cardiac cycle and exceeding ventilator trigger sensitivities. Collaborative practice optimized ventilator trigger mode and sensitivity, eliminating autotriggering. Downloading data from the Servo-I ventilator enabled retrospective analysis of waveform data in context with neurological assessment findings.</p><p>RESULTS: Cardiogenic autotriggering was confirmed in 15% of patients in this series. Cardiogenic flow deflections measured 1.5 to 12.0 L/min. Cardiogenic pressure deflections measured 1 to 9 cm H2O. Hyperdynamic cardiovascular states with elevated blood pressure and high stroke volume was strongly associated with greater amplitude of cardiogenic waveform deflections and likelihood of autotriggering in the absence of intrinsic respiratory drive. Autotriggering ended instantly when flow and pressure trigger sensitivities were increased beyond cardiogenic waveform amplitudes. This optimized timing of brain death protocols, decreased ICU length of stay, and increased organ availability for transplantation.</p><p>CONCLUSIONS: Cardiogenic autotriggering may be far more common than is realized and may significantly delay determination of brain death, increase family stress, and restrict availability of donor organs. Collaborative practice with scrutiny of neurological status and patient-ventilator interaction makes possible early recognition of autotriggering. Recognition and titration of ventilator triggering facilitates brain death determination, minimizes the ICU experience for families, and increases donor organ availability.en_GB
dc.date.available2011-10-26T19:30:32Z-
dc.date.issued2011-10-26en_GB
dc.date.accessioned2011-10-26T19:30:32Z-
dc.identifier.citation2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866en_GB
dc.conference.date2010en_GB
dc.conference.nameNational Teaching Institute and Critical Care Expositionen_GB
dc.conference.hostAmerican Association of Critical-Care Nursesen_GB
dc.conference.locationWashington, D.C., USAen_GB
dc.identifier.citation2010 National Teaching Institute Research Abstracts. American Journal of Critical Care, 19(3), e15-e28. doi:10.4037/ajcc2010866en_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.