Asynchrony Consequences and Management

Pham, Tài; Telias, Irene; Piraino, Thomas; Yoshida, Toyohiko; Brochard, Laurent

doi:10.1016/j.ccc.2018.03.008

Cited by 72 publications

(68 citation statements)

References 60 publications

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“…When the respiratory system time constant is high, (i.e., obstructive lung disease), ventilator over-assistance results in delayed cycling, dynamic hyperinflation, and increased intrinsic PEEP, predisposing to ineffective triggering. Decreasing the level of assist can therefore alleviate ineffective efforts [ 57 ]. Over-assistance in assisted ventilation can also induce apneas during sleep.…”

Section: Clinical Strategies To Facilitate Lung and Diaphragm-protectmentioning

confidence: 99%

Clinical strategies for implementing lung and diaphragm-protective ventilation: avoiding insufficient and excessive effort

et al. 2020

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Mechanical ventilation may have adverse effects on both the lung and the diaphragm. Injury to the lung is mediated by excessive mechanical stress and strain, whereas the diaphragm develops atrophy as a consequence of low respiratory effort and injury in case of excessive effort. The lung and diaphragm-protective mechanical ventilation approach aims to protect both organs simultaneously whenever possible. This review summarizes practical strategies for achieving lung and diaphragm-protective targets at the bedside, focusing on inspiratory and expiratory ventilator settings, monitoring of inspiratory effort or respiratory drive, management of dyssynchrony, and sedation considerations. A number of potential future adjunctive strategies including extracorporeal CO 2 removal, partial neuromuscular blockade, and neuromuscular stimulation are also discussed. While clinical trials to confirm the benefit of these approaches are awaited, clinicians should become familiar with assessing and managing patients’ respiratory effort, based on existing physiological principles. To protect the lung and the diaphragm, ventilation and sedation might be applied to avoid excessively weak or very strong respiratory efforts and patient-ventilator dysynchrony.

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Section: Clinical Strategies To Facilitate Lung and Diaphragm-protectmentioning

confidence: 99%

Clinical strategies for implementing lung and diaphragm-protective ventilation: avoiding insufficient and excessive effort

et al. 2020

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“…They also provided representative pressure, volume, and flow waveforms to illustrate ineffective trigger efforts, double-cycling, reverse-triggering, and inspiratory flow asynchrony. They explained that patientventilator asynchrony occurs when there is a mismatch between ventilator assistance and patient demand, noting the classification system based on this idea by Pham et al 23 This paper goes into great detail about the physiologic consequences of the listed asynchronies and, in particular, about reverse-triggering. There is also a comprehensive section on heart-lung interaction in patients with asynchronies, giving details of how they affect preload and afterload.…”

Section: Literature Reviewsmentioning

confidence: 97%

2019 Year in Review: Patient-Ventilator Synchrony

Chatburn

Mireles-Cabodevila

2020

Respir Care

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Patient-ventilator synchrony is a popular topic of research on mechanical ventilation. This review puts this research into both contemporary and historical perspective. Five areas of research are described: literature reviews, manual detection of synchrony problems, automated detection of synchrony problems, modes for improving synchrony, and effects of sedation. We note that this type of research lacks a standardized vocabulary and associated taxonomy, which generates difficulty in communication among students and researchers, as well as in comparison of results. Hence, we conclude this paper with some suggestions for improvement in that regard.

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“…Asynchrony, usually defined as a discrepancy between a patient's neural times and need and the ventilatordelivered breath, could have an impact on patient outcomes. [65][66][67][68][69] Asynchrony regularly happens when a patient is overassisted (eg, ineffective effort, delayed cycling) or underassisted (eg, premature cycling, flow starvation). Asynchrony can be challenging to detect only with P aw and flow waveforms, therefore esophageal manometry might assist in the diagnosis.…”

Section: Monitoring Inspiratory Effortmentioning

confidence: 99%

Esophageal Manometry

2020

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The estimation of pleural pressure with esophageal manometry has been used for decades, and it has been a fertile area of physiology research in healthy subject as well as during mechanical ventilation in patients with lung injury. However, its scarce adoption in clinical practice takes its roots from the (false) ideas that it requires expertise with years of training, that the values obtained are not reliable due to technical challenges or discrepant methods of calculation, and that measurement of esophageal pressure has not proved to benefit patient outcomes. Despites these criticisms, esophageal manometry could contribute to better monitoring, optimization, and personalization of mechanical ventilation from the acute initial phase to the weaning period. This review aims to provide a comprehensive but comprehensible guide addressing the technical aspects of esophageal catheter use, its application in different clinical situations and conditions, and an update on the state of the art with recent studies on this topic and on remaining questions and ways for improvement.

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Asynchrony Consequences and Management

Cited by 72 publications

References 60 publications

Clinical strategies for implementing lung and diaphragm-protective ventilation: avoiding insufficient and excessive effort

Clinical strategies for implementing lung and diaphragm-protective ventilation: avoiding insufficient and excessive effort

2019 Year in Review: Patient-Ventilator Synchrony

Esophageal Manometry

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