Patient-Ventilator Asynchronies: Clinical Implications and Practical Solutions

Abstract

Enterprises ePub ahead of print papers have been peer-reviewed, accepted for publication, copy edited and proofread. However, this version may differ from the final published version in the online and print editions of RESPIRATORY CARE appropriate monitoring of asynchronies is mandatory to improve the applied strategies and thus improve patient-ventilator interaction. We conducted a literature review regarding patient-ventilator interaction with a focus on the different kinds of inspiratory and expiratory asynchronies, their monitoring, clinical implications, possible prevention, and treatment. We believe that monitoring patient-ventilator interaction is mandatory in spontaneously breathing patients to understand, by using the available technologies, the type of asynchrony and consequently improve the adaptation of the ventilator to the patient's needs. Asynchronies are relatively frequent during mechanical ventilation in critically ill patients, and they are associated with poor outcomes. This review summarizes the different types of asynchronies and their mechanisms, consequences, and potential management. The development and understanding of monitoring tools are necessary to allow a better appraisal of this area, which may lead to better outcomes for patients.

Testing of pandemic ventilators under early and agile development

“…The correct detection of and fast reaction to a patient's breathing efforts is crucial to prevent patient–ventilator asynchrony, which may cause discomfort or even lung injury ( 21 , 22 ). A higher initial flow after triggering results in a better pressurization capacity of the ventilator and in decreased patient effort ( 23 , 24 ).…”

Non-intubated Thoracoscopic Surgery-Tips and Tricks From Anesthesiological Aspects: A Mini Review

“…It should be mentioned that there are also several disadvantages of SB during mechanical ventilation. These disadvantages include the possibility of uncontrolled inspiratory efforts that may worsen lung injury due to volutrauma or barotrauma (42,43) and increased heterogeneity of ventilation, leading to regional dorsal atelectrauma due to the cyclic opening and closing of small airways (43,44), patient-ventilator asynchrony which results in patient distress (45), increased alveolo-capillary pressure gradient which leads to interstitial edema (42,46) and impaired hemodynamics; difficulties in the feasible measurement of respiratory mechanics parameters (e.g., driving pressure) (47); and the impossibility of using NMBAs that may make endotracheal intubation and a secure airway difficult. The respiratory depression effect of major analgesics may also be a problem that requires attention.…”

Neurally Adjusted Ventilatory Assist in Acute Respiratory Failure—A Narrative Review

“…Overassistance promotes prolonged inspiratory time, late cycling, hyperinflation and intrinsic PEEP [ 28 ], which in turn increase the threshold to trigger the ventilator and therefore facilitates ineffective efforts [ 23 , 29 ]. In conventional assisted modes of ventilation, it is indeed possible to bring neural and mechanical inspiratory time closer by reducing pressure support and increasing the flow threshold for cycling off [ 30 ]. Nevertheless, detection and treatment of patient–ventilator asynchronies remains a complex task in the clinical practice.…”