Patient–Ventilator Interaction: An Overview

Prinianakis, George; Kondili, Eumorfia; Georgopoulos, Dimitris

doi:10.1016/j.rcc.2005.02.007

Cited by 27 publications

(21 citation statements)

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“…Either patient-related factors or ventilator-related factors may be responsible, and it is often the interaction between the two that results in asynchrony. 5,6,8,9 Patient-related factors include respiratory mechanics (resistance, elastance, or dynamic hyperinflation/intrinsic PEEP), minute ventilation (V E ), respiratory muscle capacity, and respiratory drive. The latter are influenced by chemical and mechanical feedback loops, respiratory reflexes, and cortical influences.…”

Section: Introductionmentioning

confidence: 99%

How Often Does Patient-Ventilator Asynchrony Occur and What Are the Consequences?

Epstein

2011

Respir Care

116

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Mechanical ventilation can be life-saving for patients with acute respiratory failure. In between the 2 extremes of complete and no ventilatory support, both patient and machine contribute to ventilatory work. Ideally, ventilator gas delivery would perfectly match patient demand. This patientventilator interaction depends on how the ventilator responds to patient respiratory effort and, in turn, how the patient responds to the breath delivered by the ventilator. It is now evident that the interaction between patient and ventilator is frequently suboptimal and that patient-ventilator asynchrony is common. Its prevalence depends on numerous factors, including timing and duration of observation, technique used for detection, patient population, type of asynchrony, ventilation mode and settings (eg, trigger, flow, and cycle criteria), and confounding factors (eg, state of wakefulness, sedation). Patient-ventilator asynchrony is associated with adverse effects, including higher/wasted work of breathing, patient discomfort, increased need for sedation, confusion during the weaning process, prolonged mechanical ventilation, longer stay, and possibly higher mortality. Whether asynchrony is a marker of poor prognosis or causes these adverse outcomes remains to be determined.

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Section: Introductionmentioning

confidence: 99%

How Often Does Patient-Ventilator Asynchrony Occur and What Are the Consequences?

Epstein

2011

Respir Care

116

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“…When interpreting ventilator waveforms, it is important to differentiate between dependent and independent variables, based on the set mode of ventilation. (1,(3)(4)(5)(11)(12)(13)(14)(15)(16)(17) …”

Section: Mechanisms Of Patient-ventila-tion Asynchronymentioning

confidence: 99%

Bedside detection of patient-ventilation asynchrony

2016

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Patient-ventilator asynchrony is common but under-recognized and under-reported. The frequency of PAV is reported around 23%, but up to 93% of patients have at least one episode of PVA. While sporadic asynchronies may have uncertain clinical impact, when they amount to more than 10% of the total breaths, PVA can increase the need for sedation and reduce sleep quality. In addition, they can impact on outcome by prolonging mechanical ventilation and increasing both ICU and hospital mortality. The purpose of this review is threefold: 1) to characterise different types of patientventilator interaction; 2) to describe mechanisms leading to asynchrony; and 3) to describe ventilator modification to reduce patient-ventilation asynchrony.

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“…The acute phase of respiratory failure may require clinician suppression of this spontaneous respiratory drive and the use of controlled mechanical ventilation in which the ventilator has sole control over the respiratory rate and minute ventilation [14,15]. Under these conditions, respiratory muscles are inactive.…”

Section: Pathophysiology Of Patient-ventilator Dyssynchronymentioning

confidence: 99%