Patient-ventilator flow dyssynchrony

MacIntyre, Neil R.; McConnell, Robert; Cheng, Kuo‐Chen; Sane, A. S.

doi:10.1097/00003246-199710000-00016

Cited by 83 publications

(11 citation statements)

References 37 publications

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“…(17) Switching to modes in which the fl ow and volume vary in response to patient effort, such as PSV and PCV, can improve comfort. (18) However, choosing a ventilatory mode that allows the patient to have a certain control over inspiratory fl ow, such as PCV or PSV, does not ensure optimal patient-ventilator interaction. For the application of PCV and PSV, the choice of the level of support to be delivered is essential and should be individualized.…”

Section: Ventilator-related Factorsmentioning

confidence: 99%

“…In both cases, there is stacking of tidal volumes, resulting in distension of the lung parenchyma, with a corresponding increase in alveolar and airway pressures, and posing a risk of ventilator-induced lung injury, particularly in patients with ARDS. (2,(17)(18)(19) The main therapeutic strategy in such cases consists of increasing inspiratory time (in VCV and PCV), and, in PSV mode, it consists of increasing inspiratory time by decreasing the cycling percentage of peak fl ow.…”

Section: Types Of Asynchrony Diagnoses and Strategiesmentioning

confidence: 99%

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Patient-ventilator asynchrony

et al. 2018

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Patient-v entilator asynchrony (PVA) is a mismatch between the patient, regarding time, flow, volume, or pressure demands of the patient respiratory system, and the ventilator, which supplies such demands, during mechanical ventilation (MV). It is a common phenomenon, with incidence rates ranging from 10% to 85%. PVA might be due to factors related to the patient, to the ventilator, or both. The most common PVA types are those related to triggering, such as ineffective effort, auto-triggering, and double triggering; those related to premature or delayed cycling; and those related to insufficient or excessive flow. Each of these types can be detected by visual inspection of volume, flow, and pressure waveforms on the mechanical ventilator display. Specific ventilatory strategies can be used in combination with clinical management, such as controlling patient pain, anxiety, fever, etc. Deep sedation should be avoided whenever possible. PVA has been associated with unwanted outcomes, such as discomfort, dyspnea, worsening of pulmonary gas exchange, increased work of breathing, diaphragmatic injury, sleep impairment, and increased use of sedation or neuromuscular blockade, as well as increases in the duration of MV, weaning time, and mortality. Proportional assist ventilation and neurally adjusted ventilatory assist are modalities of partial ventilatory support that reduce PVA and have shown promise. This article reviews the literature on the types and causes of PVA, as well as the methods used in its evaluation, its potential implications in the recovery process of critically ill patients, and strategies for its resolution.

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Section: Ventilator-related Factorsmentioning

confidence: 99%

Section: Types Of Asynchrony Diagnoses and Strategiesmentioning

confidence: 99%

Patient-ventilator asynchrony

et al. 2018

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“…Potential consequences of low assistance are excessive load on the respiratory muscles, air hunger promoting limbic, paralimbic, and cerebellar activation in the brain [15], and ventilator-induced lung injury due to excessive tidal volume. Moreover, strong inspiratory efforts can increase transvascular pressure gradients and tidal recruitment associated with pendelluft flow and regional lung overdistension [16, 17]. Vigorous spontaneous efforts impact non-dependent and dependent lung regions differently, increasing inspiratory distension but also apparently worsening injury in the dependent lung because diaphragm contraction is poorly transmitted to the remainder of the pleural surface and is thus “confined” to the dependent lung [18].…”

Section: Main Textmentioning

confidence: 99%

Patient-ventilator asynchronies during mechanical ventilation: current knowledge and research priorities

Haro

Ochagavía

López-Aguilar

et al. 2019

ICMx

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Background Mechanical ventilation is common in critically ill patients. This life-saving treatment can cause complications and is also associated with long-term sequelae. Patient-ventilator asynchronies are frequent but underdiagnosed, and they have been associated with worse outcomes. Main body Asynchronies occur when ventilator assistance does not match the patient’s demand. Ventilatory overassistance or underassistance translates to different types of asynchronies with different effects on patients. Underassistance can result in an excessive load on respiratory muscles, air hunger, or lung injury due to excessive tidal volumes. Overassistance can result in lower patient inspiratory drive and can lead to reverse triggering, which can also worsen lung injury. Identifying the type of asynchrony and its causes is crucial for effective treatment. Mechanical ventilation and asynchronies can affect hemodynamics. An increase in intrathoracic pressure during ventilation modifies ventricular preload and afterload of ventricles, thereby affecting cardiac output and hemodynamic status. Ineffective efforts can decrease intrathoracic pressure, but double cycling can increase it. Thus, asynchronies can lower the predictive accuracy of some hemodynamic parameters of fluid responsiveness. New research is also exploring the psychological effects of asynchronies. Anxiety and depression are common in survivors of critical illness long after discharge. Patients on mechanical ventilation feel anxiety, fear, agony, and insecurity, which can worsen in the presence of asynchronies. Asynchronies have been associated with worse overall prognosis, but the direct causal relation between poor patient-ventilator interaction and worse outcomes has yet to be clearly demonstrated. Critical care patients generate huge volumes of data that are vastly underexploited. New monitoring systems can analyze waveforms together with other inputs, helping us to detect, analyze, and even predict asynchronies. Big data approaches promise to help us understand asynchronies better and improve their diagnosis and management. Conclusions Although our understanding of asynchronies has increased in recent years, many questions remain to be answered. Evolving concepts in asynchronies, lung crosstalk with other organs, and the difficulties of data management make more efforts necessary in this field.

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“…12 In general, the lack of a fixed flow rate in AC-PC may improve patient–ventilator synchrony, but it is unclear whether this translates into improved outcomes. 13…”

Section: Components Of Invasive Mechanical Ventilationmentioning

confidence: 99%

Invasive Mechanical Ventilation

Walter

Corbridge

Singer

2018

Southern Medical Journal

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Invasive mechanical ventilation is a potentially lifesaving intervention for acutely ill patients. The goal of this review was to provide a concise, clinically focused overview of basic invasive mechanical ventilation for the many clinicians who care for mechanically ventilated patients. Attention is given to how common ventilator modes differ in delivering a mechanical breath, evaluation of respiratory system mechanics, how to approach acute changes in airway pressure, and the diagnosis of auto-positive end-expiratory pressure. Waveform interpretation is emphasized throughout the review.

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Patient-ventilator flow dyssynchrony

Abstract: The pressure-limited, variable-flow approach to ventilator gas delivery appears to be more responsive to a vigorous patient effort than a fixed-flow approach.

Cited by 83 publications

References 37 publications

Patient-ventilator asynchrony

Patient-ventilator asynchrony

Patient-ventilator asynchronies during mechanical ventilation: current knowledge and research priorities

Invasive Mechanical Ventilation

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