Classifying reverse triggering breaths: A clinically oriented approach

Asynchronies during mechanical ventilation, particularly reverse triggering (RT), is a common phenomenon in critically ill patients, with prevalence estimates between 30% and 60%. RT is characterized by the activation of respiratory muscles induced by the passive insufflation, which can impact pulmonary physiology and diaphragmatic function, increasing the risk of lung injury and muscle damage. The proposed classification of RT in this article is based on five key criteria which suppose a structured evaluation of RT phenotypes. This classification criteria would allow differentiation between events that may be beneficial, such as maintaining diaphragm activity and improving oxygenation, and injurious episodes, including breath stacking and high efforts that exacerbate pulmonary and muscular injury. Understanding and classifying RT in detail enables clinicians to make more precise decisions and implement personalized interventions, thereby improving the safety and effectiveness of mechanical ventilation in critical care settings. This comprehensive approach provides a foundation for future research to validate its clinical utility, identify high-risk patient phenotypes, and develop targeted therapies. Keywords: reverse trigger, phenotypes, classification, timing