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Patient-ventilator asynchronies: may the respiratory mechanics play a role?

Carlucci A, Pisani L, Ceriana P, Malovini A, Nava S - Crit Care (2013)

Bottom Line: In the last 15 minutes of this period, asynchrony events were detected and classified as ineffective effort (IE), double triggering (DT) and auto-triggering (AT).IEs were the most frequent asynchronous events (45% of patients) and were associated with a higher level of pressure support.A high incidence of asynchrony events and IE were associated with a poor tolerance of NIV.

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ABSTRACT

Introduction: The mechanisms leading to patient/ventilator asynchrony has never been systematically assessed. We studied the possible association between asynchrony and respiratory mechanics in patients ready to be enrolled for a home non-invasive ventilatory program. Secondarily, we looked for possible differences in the amount of asynchronies between obstructive and restrictive patients and a possible role of asynchrony in influencing the tolerance of non-invasive ventilation (NIV).

Methods: The respiratory pattern and mechanics of 69 consecutive patients with chronic respiratory failure were recorded during spontaneous breathing. After that patients underwent non-invasive ventilation for 60 minutes with a "dedicated" NIV platform in a pressure support mode during the day. In the last 15 minutes of this period, asynchrony events were detected and classified as ineffective effort (IE), double triggering (DT) and auto-triggering (AT).

Results: The overall number of asynchronies was not influenced by any variable of respiratory mechanics or by the underlying pathologies (that is, obstructive vs restrictive patients). There was a high prevalence of asynchrony events (58% of patients). IEs were the most frequent asynchronous events (45% of patients) and were associated with a higher level of pressure support. A high incidence of asynchrony events and IE were associated with a poor tolerance of NIV.

Conclusions: Our study suggests that in non-invasively ventilated patients for a chronic respiratory failure, the incidence of patient-ventilator asynchronies was relatively high, but did not correlate with any parameters of respiratory mechanics or underlying disease.

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Distribution of total and single types of asynchrony in overall studied population.
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Figure 1: Distribution of total and single types of asynchrony in overall studied population.

Mentions: As shown in Figure 1, any form of asynchrony was present in 58% of the 69 enrolled patients, with IE being by far the most common problem. An AI >10%, indicating severe asynchrony [3], was present in 21/69 (30%) patients, while IE >10% were detected in 14/69 (20%) of patients.


Patient-ventilator asynchronies: may the respiratory mechanics play a role?

Carlucci A, Pisani L, Ceriana P, Malovini A, Nava S - Crit Care (2013)

Distribution of total and single types of asynchrony in overall studied population.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3672543&req=5

Figure 1: Distribution of total and single types of asynchrony in overall studied population.
Mentions: As shown in Figure 1, any form of asynchrony was present in 58% of the 69 enrolled patients, with IE being by far the most common problem. An AI >10%, indicating severe asynchrony [3], was present in 21/69 (30%) patients, while IE >10% were detected in 14/69 (20%) of patients.

Bottom Line: In the last 15 minutes of this period, asynchrony events were detected and classified as ineffective effort (IE), double triggering (DT) and auto-triggering (AT).IEs were the most frequent asynchronous events (45% of patients) and were associated with a higher level of pressure support.A high incidence of asynchrony events and IE were associated with a poor tolerance of NIV.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Introduction: The mechanisms leading to patient/ventilator asynchrony has never been systematically assessed. We studied the possible association between asynchrony and respiratory mechanics in patients ready to be enrolled for a home non-invasive ventilatory program. Secondarily, we looked for possible differences in the amount of asynchronies between obstructive and restrictive patients and a possible role of asynchrony in influencing the tolerance of non-invasive ventilation (NIV).

Methods: The respiratory pattern and mechanics of 69 consecutive patients with chronic respiratory failure were recorded during spontaneous breathing. After that patients underwent non-invasive ventilation for 60 minutes with a "dedicated" NIV platform in a pressure support mode during the day. In the last 15 minutes of this period, asynchrony events were detected and classified as ineffective effort (IE), double triggering (DT) and auto-triggering (AT).

Results: The overall number of asynchronies was not influenced by any variable of respiratory mechanics or by the underlying pathologies (that is, obstructive vs restrictive patients). There was a high prevalence of asynchrony events (58% of patients). IEs were the most frequent asynchronous events (45% of patients) and were associated with a higher level of pressure support. A high incidence of asynchrony events and IE were associated with a poor tolerance of NIV.

Conclusions: Our study suggests that in non-invasively ventilated patients for a chronic respiratory failure, the incidence of patient-ventilator asynchronies was relatively high, but did not correlate with any parameters of respiratory mechanics or underlying disease.

Show MeSH
Related in: MedlinePlus