An Analysis of Desynchronization Between the Spontaneously Breathing Patient and Ventilator During Inspiratory Pressure Support

Fabry, Ben; Guttmann, J.; Eberhard, L.; Bauer, Tilman; Haberthür, Christoph; Wolff, G.

doi:10.1378/chest.107.5.1387

Cited by 123 publications

(72 citation statements)

References 9 publications

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“…Typically, in patients with COPD a marked timing asynchrony between the expiratory phase of the breathing cycle (neural expiration) and the opening of the ventilator's expiratory valve (mechanical expiration) may be present. 2,3 As discussed further in this paper, patient-ventilator asynchrony is associated with adverse outcomes. 4,5 In order to resolve these problems, a new ventilation mode, proportional assist ventilation (PAV), was proposed.…”

Section: From Controlled Mechanical Ventilation To Assisted Mechanicamentioning

confidence: 91%

“…[3][4][5]11,12 Patient-ventilator asynchrony occurs primarily in patients with a high intrinsic respiratory frequency, in patients with chronic airway obstruction, and in patients who are ventilated with a high level of pressure support resulting in a tidal volume exceeding their habitual tidal volume. 3,4 Patient-ventilator asynchrony can be attributed to pathological patient-related factors and to technical factors (inappropriate ventilator settings or technical defect of the ventilator). 9,10 The main patient-related determinant of substantial patient-ventilator asynchrony during assisted ventilation modes is the presence of intrinsic PEEP and dynamic hyperinflation.…”

Section: The Importance Of Patient-ventilator Synchronymentioning

confidence: 99%

“…2 Patient-ventilator asynchrony is associated with (1) an increased need for sedation and neuromuscular blockade, (2) increased transpulmonary pressure, with a risk of barotrauma and ventilator-induced lung injury, and (3) prolonged duration of mechanical ventilation. [3][4][5]11,12 In addition, enhanced patient-ventilator synchrony is associated with greater patient comfort and better quality of sleep. 14 Inadequate quality of sleep is associated with a greater risk of delirium and may contribute to mortality.…”

Section: The Importance Of Patient-ventilator Synchronymentioning

confidence: 99%

“…A patient with respiratory insufficiency has an excessively high EA di signal as an expression of an insufficient reserve of the neuro-ventilatory coupling, which fails to meet the patient's respiratory needs. 3,[21][22][23] The EA di signal may also vary intra-individually, depending on the stage of disease and the physiologic reserve of the respiratory system. 24 Thus, the evolution of the EA di signal can be used as a measure of the progression of the respiratory function and possibly help predict the success of weaning from mechanical ventilation.…”

Section: Interpretation Of the Diaphragm Signalmentioning

confidence: 99%

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Neurally Adjusted Ventilatory Assist: A Ventilation Tool or a Ventilation Toy?

Verbrugghe

Jorens

2011

Respir Care

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Mechanical ventilation has, since its introduction into clinical practice, undergone a major evolution from controlled ventilation to various modes of assisted ventilation. Neurally adjusted ventilatory assist (NAVA) is the newest development. The implementation of NAVA requires the introduction of a catheter to measure the electrical activity of the diaphragm (EA di ). NAVA relies, opposite to conventional assisted ventilation modes, on the EA di to trigger the ventilator breath and to adjust the ventilatory assist to the neural drive. The amplitude of the ventilator assist is determined by the instantaneous EA di and the NAVA level set by the clinician. The NAVA level amplifies the EA di signal and determines instantaneous ventilator assist on a breath-to-breath basis. Experimental and clinical data suggest superior patient-ventilator synchrony with NAVA. Patient-ventilator asynchrony is present in 25% of mechanically ventilated patients in the intensive care unit and may contribute to patient discomfort, sleep fragmentation, higher use of sedation, development of delirium, ventilator-induced lung injury, prolonged mechanical ventilation, and ultimately mortality. With NAVA, the reliance on the EA di signal, together with an intact ventilatory drive and intact breathing reflexes, allows integration of the ventilator in the neuro-ventilatory coupling on a higher level than conventional ventilation modes. The simple monitoring of the EA di signal alone may provide the clinician with important information to guide ventilator management, especially during the weaning process. Although, until now, little evidence proves the superiority of NAVA on clinically relevant end points, it seems evident that patient populations (eg, COPD and small children) with major patient-ventilator asynchrony may benefit from this new ventilatory tool.

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Section: From Controlled Mechanical Ventilation To Assisted Mechanicamentioning

confidence: 91%

Section: The Importance Of Patient-ventilator Synchronymentioning

confidence: 99%

Section: The Importance Of Patient-ventilator Synchronymentioning

confidence: 99%

Section: Interpretation Of the Diaphragm Signalmentioning

confidence: 99%

See 2 more Smart Citations

Neurally Adjusted Ventilatory Assist: A Ventilation Tool or a Ventilation Toy?

Verbrugghe

Jorens

2011

Respir Care

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“…Dynamic hyperinflation associated with large V T during pressure support ventilation (PSV) in patients with elevated airways resistance and normal pulmonary compliance (eg, COPD) are the most often described reason for missed triggers. [17][18][19][20][21][22][23] Missed triggers can also occur during volume control ventilation.…”

Section: Missed Triggersmentioning

confidence: 99%

Asynchrony and DyspneaDiscussion

2013

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SummaryPatient-ventilator synchrony and patient comfort are assumed to go hand in hand, yet few studies provide support for this common sense idea. In reality, synchrony between the patient and ventilator is complex and can be affected by the ventilator settings, type of ventilator, patient-ventilator interface, and sedation. Inspections of airway pressure and flow waveforms are reliable methods for detecting asynchrony, and automated detection seems accurate. A number of types of asynchronies have been defined, and asynchrony during invasive and noninvasive ventilation have different calling cards. There is a clear association between asynchrony, ventilator-induced diaphragmatic dysfunction, and duration of mechanical ventilation. Whether these are cause and effect or simply associated remains to be determined.

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Assisted Ventilation

Shneerson¹

2000

Crofton and Douglas's Respiratory Diseases

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An Analysis of Desynchronization Between the Spontaneously Breathing Patient and Ventilator During Inspiratory Pressure Support

Cited by 123 publications

References 9 publications

Neurally Adjusted Ventilatory Assist: A Ventilation Tool or a Ventilation Toy?

Neurally Adjusted Ventilatory Assist: A Ventilation Tool or a Ventilation Toy?

Asynchrony and DyspneaDiscussion

Assisted Ventilation

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