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Additional file 1. Online Supplement.

The authors would like to provide the list of the BEARDS investigators (Incidence of Breathing efforts in Early ARDS, NCT03447288), omitted in the original version of the manuscript. The study would not have been possible without the work of all participants. Tracings used in the analysis were collected by BEARDS investigators and as such, they must be cited as collaborators. The BEARDS sites, and investigators and their affiliations are the following: 1. Saint Michael's hospital, Unity Health Toronto, Toronto, Ontario, Canada: Laurent Brochard, Irene Telias, Felipe Damiani, Ricard Mellado Artigas, Cesar Santis, Tài Pham2. Dipartimento di Anestesia, Rianimazione ed. Emergenza-Urgenza, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli studi di Milano, Milan, Italy. Tommaso Mauri, Elena Spinelli, Giacomo Grasselli, Nadia Corcione, Francesca Dalla Corte3. Department of Morphology, Surgery and Experimental Medicine. Section of Intensive Care Unit, University of Ferrara, Sant'Anna Hospital, Ferrara, Italy: Savino Spadaro, Carlo Alberto Volta4. Anesthesia and Intensive Care, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Policlinico San Matteo, Pavia, Italy: Francesco Mojoli5. Department of Intensive Care Medicine, University Hospital of Heraklion and School of Medicine, University of Crete, Heraklion, Crete, Greece: Dimitris Georgopoulos, Eumorfia Kondili, Stella Soundoulounaki6. Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany.: Tobias Becher, Norbert Weiler, Dirk Schaedler7. Critical Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute and Ciber Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain: Oriol Roca, Manel Santafe8. Intensive Care Medicine, Hospital de Sant Pau, Barcelona, Spain: Jordi Mancebo, Nuria Rodriguez9. Department of intensive Care, Amsterdam UMC location VUmc, Amsterdam, the Netherlands. Amsterdam Cardiovascular Sciences research institute, Amsterdam, and Dept of intensive care bij Erasmus MCRotterdam, Zuid-Holland, Netherlands: Leo Heunks, Heder de Vries10. National Cheng Kung University Hospital, College of Medicine, National Cheng-Kung University, Tainan, Taiwan: Chang Wen Chen11. Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, China: Jian-Xin Zhou周建新, Guang-Qiang Chen 陈光强12. Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand: Nuttapol Rittayamai13. PT, Unidad de Terapia Intensiva, Complejo Médico Policía Federal Argentina Churruca Visca: Norberto Tiribelli14. Sanatorio de la Trinidad Mitre, Buenos Aires, Argentina: Sebastian Fredes15. Hospital Clinic, Barcelona, Spain: Ricard Artigas Mellado, Carlos Ferrando Ortolá16. Medical Intensive Care Unit, University Hospital of Angers, Angers, France: François Beloncle, Alain Mercat17. Service de Réanimation Polyvalente, Hôpital Sainte Musse, Toulon, France: Jean-Michel Arnal18. Medical Intensive Care Unit Hôpital Européen Georges Pompidou Assistance Publique-Hôpitaux de Paris, Paris, France: Jean-Luc Diehl, Romy Younan19. AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine intensive - Réanimation (Département ‘R3S’), Paris, France: Alexandre Demoule, Martin Dres, Quentin Fossé20. Groupe Hospitalier Sud Ile-De-France, Centre Hospitalier de Melun, Melun, France: Sébastien Jochmans, Jonathan Chelly21. Médecine Intensive Réanimation, C.H·U de Grenoble-Alpes, Grenoble, France: Nicolas Terzi, Claude Guérin22. Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA: Elias Baedorf Kassis23. Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University College of Physicians and Surgeons, NewYork-Presbyterian Hospital, New York, New York, USA: Jeremy Beitler24. Department of anesthesua and intensive care, Sao Paolo Hospital, University of Milano, Milano, Italy: Davide Chiumello, Erica Ferrari Luca Bolgiaghi25. Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France: Arnaud W Thille, Rémi Coudroy26. Assistance Publique - Hôpitaux de Marseille, Hôpital Nord, Médecine Intensive Réanimation; Aix-Marseille Université, Faculté de médecine, Centre d'Etudes et de Recherches sur les Services de Santé et qualité de vie EA 3279, 13,005, Marseille, France: Laurent Papazian, Christophe Guervilly

Purpose: An inspiratory hold during patient-triggered assisted ventilation potentially allows to measure driving pressure and inspiratory effort. However, muscular activity can make this measurement unreliable. We aim to define the criteria for inspiratory holds reliability during patient-triggered breaths. Material and methods: Flow, airway and esophageal pressure recordings during patient-triggered breaths from a multicentre observational study (BEARDS, NCT03447288) were evaluated by six independent raters, to determine plateau pressure readability. Features of “readable” and “unreadable” holds were compared. Muscle pressure estimate from the hold was validated against other measures of inspiratory effort. Results: Ninety-two percent of the recordings were consistently judged as readable or unreadable by at least four raters. Plateau measurement showed a high consistency among raters. A short time from airway peak to plateau pressure and a stable and longer plateau characterized readable holds. Unreadable plateaus were associated with higher indexes of inspiratory effort. Muscular pressure computed from the hold showed a strong correlation with independent indexes of inspiratory effort. Conclusion: The definition of objective parameters of plateau reliability during assisted-breath provides the clinician with a tool to target a safer assisted-ventilation and to detect the presence of high inspiratory effort.

Additional file 1. Methods, Results and Tables.

Additional file 4: Table S1. Agreement between measured and predicted Pmus and Î PL.

Additional file 5: Table S2. Discriminative performance of predicted Pmus and Î PL values to detect excessive Pmus and Î PL.

Additional file 1. Electronic supplementary material.

Additional file 1. Supplemental description of methods.

Additional file 1. Supplemental description of methods.