Monitoring the patient–ventilator asynchrony during non-invasive ventilation

Abstract

Patient–ventilator asynchrony is a major issue during non-invasive ventilation and may lead to discomfort and treatment failure. Therefore, the identification and prompt management of asynchronies are of paramount importance during non-invasive ventilation (NIV), in both pediatric and adult populations. In this review, we first define the different forms of asynchronies, their classification, and the method of quantification. We, therefore, describe the technique to properly detect patient–ventilator asynchronies during NIV in pediatric and adult patients with acute respiratory failure, separately. Then, we describe the actions that can be implemented in an attempt to reduce the occurrence of asynchronies, including the use of non-conventional modes of ventilation. In the end, we analyzed what the literature reports on the impact of asynchronies on the clinical outcomes of infants, children, and adults.

Qualitative study of COVID-19 patient experiences with non-invasive ventilation and pronation: strategies to enhance treatment adherence

“…NIV failure is a major problem because it is associated with adverse clinical outcomes, such as mortality and prolonged mechanical ventilation. 9 Few studies have been conducted on the experience of patient adaptation during NIV with mask or helmet and pronation with the patient awake and mostly on patients with COPD, none during the combination of these two treatments. [10][11][12][13] This knowledge gap does not give the patient a voice, risks limiting the ability of healthcare providers and missing out on those elements of care intrinsic to the patient, which can lead to better adherence and compliance.…”

“…Despite these advantages, maintaining the prone position can be particularly challenging, as poor comfort has been described as the main cause of prone disruption. NIV failure is a major problem because it is associated with adverse clinical outcomes, such as mortality and prolonged mechanical ventilation 9…”

“…NIV failure is a major problem because it is associated with adverse clinical outcomes, such as mortality and prolonged mechanical ventilation. 9 …”

Improving Noninvasive Ventilation for Bronchiolitis: It Is Here to Stay!*

“…Logically, optimizing the patient-ventilator synchrony: receiving IPAP when the patient is inspiring should maximize these effects, is the key for bilevel NIV to be effective. The challenges of patient synchrony with NIV are well reported, especially with smaller children (4). Lung simulators have been used to demonstrate the superiority of dedicated NIV devices to detect triggering compared with ICU ventilators, even with a NIV mode (5).…”