Assessment of Physiologic Variables and Subjective Comfort Under Different Levels of Pressure Support Ventilation

Vitacca, Michele; Bianchi, Luca; Zanotti, E; Vianello, Andrea; Barbano, Luca; Porta, Roberto; Clini, Enrico

doi:10.1378/chest.126.3.851

Cited by 107 publications

(58 citation statements)

References 27 publications

(36 reference statements)

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“…1,[6][7][8] Ineffective triggering was defined as a simultaneous decrease in airway pressure and an increase in air flow, without an assisted breath (a wasted patient effort) (Fig. 1).…”

Section: Asynchrony Criteriamentioning

confidence: 99%

Patient-Ventilator Asynchrony in a Traumatically Injured Population

et al. 2013

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BACKGROUND: Prolonged mechanical ventilation, longer hospital stay, and a lower rate of home discharge have been reported with patient-ventilator asynchrony in medical patients. Though commonly encountered, asynchrony is poorly defined within the traumatically injured population. METHODS: Mechanically ventilated trauma patients at an urban, level-1 center were enrolled. Breath waveforms were recorded over 30 min within the first 48 hours following intubation. Asynchronous breaths were defined as ineffective patient triggering, double-triggering, short-cycle breaths, and long-cycle breaths. Asynchronous subjects were defined as having asynchrony in > 10% of total breaths. Demographic, injury, sedation/delirium scores, and clinical and discharge outcomes were prospectively collected. RESULTS: We enrolled 35 subjects: median age 47 y, 77.1% male, 28.6% with penetrating injuries, 16% with a history of COPD, median (IQR) Injury Severity Score 22 (17-27), and median (IQR) chest Abbreviated Injury Scale score 2 (0 -6). We analyzed 15,445 breaths. Asynchrony was present in 25.7% of the subjects. No statistical differences between the asynchronous and non-asynchronous subjects were found for age, sex, injury mechanism, COPD history, delirium/sedation scores, P aO 2 /F IO 2 , PEEP, blood gas values, or sedative, narcotic, or haloperidol use. Asynchronous subjects more commonly used synchronized intermittent mandatory ventilation (SIMV) (100% vs 38.5%, P ‫؍‬ .002) and took fewer median spontaneous breaths/min: 4 breaths/min (IQR 3-8 breaths/min) vs 12 breaths/min (IQR 9 -14 breaths/min) (P ‫؍‬ .007). SIMV with set breathing frequencies of > 10 breaths/min was associated with increased asynchrony rates (85.7% vs 14.3%, P ‫؍‬ .02). We found no difference in ventilator days, ICU or hospital stay, percent discharged home, or mortality between the asynchronous and non-asynchronous subjects. CON-CLUSIONS: Ventilator asynchrony is common in trauma patients. It may be associated with SIMV with a set breathing frequency of > 10 breaths/min, though not with longer mechanical ventilation, longer stay, or discharge disposition. (ClinicalTrials.gov NCT01049958)

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“…1,[6][7][8] Ineffective triggering was defined as a simultaneous decrease in airway pressure and an increase in air flow, without an assisted breath (a wasted patient effort) (Fig. 1).…”

Section: Asynchrony Criteriamentioning

confidence: 99%

Patient-Ventilator Asynchrony in a Traumatically Injured Population

et al. 2013

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“…However, our results should be generalized with caution in actively breathing patients, even if the breathing pattern of the subjects in our study is similar to that of patients with acute respiratory failure of different etiologies during assisted ventilation. 7,26,27 We cannot exclude the possibility that the activity of expiratory muscles could modify the findings of our study. In subjects without flow limitation, total PEEP could be decreased by active expiration, and hyperinflation could be actively limited with increased effort of the expiratory muscles.…”

Section: Discussionmentioning

confidence: 81%

Assessment of Factors Related to Auto-PEEP

et al. 2015

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“…23 Before increasing the pressures, attention to other settings may improve ventilation, comfort, adherence, and asynchrony. We present one way these goals (increase alveolar ventilation, improve nocturnal muscle rest to allow for adequate spontaneous daytime ventilation, and avoid tracheostomy) can be achieved.…”

Section: Discussionmentioning

confidence: 99%