Outcomes of ventilatory asynchrony in patients with inspiratory effort

Abstract

Objective To identify the relationship of patient-ventilator asynchrony with the level of sedation and hemogasometric and clinical results. Methods This was a prospective study of 122 patients admitted to the intensive care unit who underwent > 24 hours of invasive mechanical ventilation with inspiratory effort. In the first 7 days of ventilation, patient-ventilator asynchrony was evaluated daily for 30 minutes. Severe patient-ventilator asynchrony was defined as an asynchrony index > 10%. Results A total of 339,652 respiratory cycles were evaluated in 504 observations. The mean asynchrony index was 37.8% (standard deviation 14.1 - 61.5%). The prevalence of severe patient-ventilator asynchrony was 46.6%. The most frequent patient-ventilator asynchronies were ineffective trigger (13.3%), autotrigger (15.3%), insufficient flow (13.5%), and delayed cycling (13.7%). Severe patient-ventilator asynchrony was related to the level of sedation (ineffective trigger: p = 0.020; insufficient flow: p = 0.016; premature cycling: p = 0.023) and the use of midazolam (p = 0.020). Severe patient-ventilator asynchrony was also associated with hemogasometric changes. The persistence of severe patient-ventilator asynchrony was an independent risk factor for failure of the spontaneous breathing test, ventilation time, ventilator-associated pneumonia, organ dysfunction, mortality in the intensive care unit, and length of stay in the intensive care unit. Conclusion Patient-ventilator asynchrony is a frequent disorder in critically ill patients with inspiratory effort. The patient’s interaction with the ventilator should be optimized to improve hemogasometric parameters and clinical results. Further studies are required to confirm these results.

Transnasal High-Flow Oxygen Therapy versus Noninvasive Positive Pressure Ventilation in the Treatment of COPD with Type II Respiratory Failure: A Meta-Analysis

“…NIV has been shown to reduce intubation rate and improve the survival rate of COPD patients requiring ventilation support, and it is recommended to be used in the treatment of COPD patients with type II respiratory failure [ 25 ]. However, NIV has disadvantages, such as reduced comfort and poor interaction and synchronization between patients and ventilators, which are often difficult to identify and manage [ 26 ]. In recent years, HFNC has been increasingly applied in stabilizing and aggravating COPD patients [ 27 ].…”

2020 Year in Review: Mechanical Ventilation During the First Year of the COVID-19 Pandemic

“…[75][76][77] A decade ago evidence suggested patient-ventilator asynchrony was associated with worse outcomes, 78 and more recent evidence suggests that persistent, severe patientventilator asynchrony may be particularly harmful. 79 In this context the issue of whether P-SILI is a factor in COVID-19 progression (and its potential exacerbation by dyspnea frequently associated with V Tmismatching during LPV), raises legitimate cause for concern (see below).…”

Neurally-Adjusted Ventilatory Assist (NAVA) versus Pneumatically Synchronized Ventilation Modes in Children Admitted to PICU

“…Patient-ventilator asynchrony (P-VA) and discomfort occur in up to 30% of children [ 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. In critically ill adults, P-VA prolongs weaning time, with a significantly increased duration of ventilation, length-of-stay (LOS), and risk of complications [ 13 , 14 , 15 , 16 ]. Positive pressure ventilation is also known to induce diaphragm atrophy [ 17 ].…”