Ability of ICU Health-Care Professionals to Identify Patient-Ventilator Asynchrony Using Waveform Analysis

Ramírez, I.I.; Arellano, D.; Adasme, Rodrigo; Landeros, Jose M; Salinas, Francisco A; Vargas, Alvaro G; Vasquez, Francisco J; Lobos, Ignacio A; Oyarzun, Magdalena L; Restrepo, Ruben D

doi:10.4187/respcare.04750

Cited by 58 publications

(62 citation statements)

References 16 publications

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“…The cycle variable can be defined as "the variable (usually pressure, volume, flow, or time) that is measured and used to end inspiration (and begins expiratory flow) [10]. Premature cycling as well as double triggering is a type of asynchrony that occurs when the patient's neural inspiratory time is greater than the inspiratory time programmed in the ventilator [8].…”

Section: Premature Cyclingmentioning

confidence: 99%

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Identifying Patient-Ventilator Asynchrony Using Waveform Analysis

Arellano¹

2017

PMCOA

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A significant percentage of mechanically ventilated patients in Intensive Care Units (ICUs) show some type of patient-ventilator asynchrony (PVA). The presence of PVA is associated with complications that affect the clinical outcome and the goals for which mechanical ventilation is used in critically ill patients. Currently, mechanical ventilators are able to show different types of waveforms that allow to identify the different types of PVA in a noninvasive and reliable way. However, in order to perform an adequate interpretation and management of the PVA the health care professionals must be properly trained in the topic.

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Section: Premature Cyclingmentioning

confidence: 99%

“…Therefore, the identification of PVA is not an easy task. Ramírezet al [10] evaluated the ability of 366 professionals that work in ICUs to identify PVA using waveform analysis. Their results showed that only 21% of health care professionals were able to recognize all types PVAs.…”

Section: Introductionmentioning

confidence: 99%

Identifying Patient-Ventilator Asynchrony Using Waveform Analysis

Arellano¹

2017

PMCOA

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“…We sincerely thank Jeffrey Haynes for his comments on our study. 1 We agree with Mr Haynes when he points out that there are occasions in which patient-ventilator asynchrony cannot be identified by standard waveform analysis and that other assessment tools, such as diaphragmatic electromyography, are needed to effectively identify its presence. This is a very important point, considering that a significant percentage of asynchronies are underestimated using standard waveform analysis.…”

Section: Patient-ventilator Asynchrony and Standard Waveforms: Looks mentioning

confidence: 61%

Patient-Ventilator Asynchrony and Standard Waveforms: Looks Can Be Deceiving

Haynes

2017

Respir Care

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“…(7) A study of health professionals found that specifi c training on MV improves the ability of these professionals to detect asynchrony on the basis of observation of waveforms on the mechanical ventilator display; however, this detection ability was not affected by length of experience or health professional type (nurse, physician, or physical therapist). (51) Therefore, the development of automatic detection methods could improve the diagnosis of asynchrony, inform health professionals, and potentially be used in the future to suggest ventilator adjustments or even to provide the basis for automation of ventilator adjustments. (52) Several algorithms that can detect wasted efforts, double triggering, or asynchrony in general have been developed, but their bedside application is still restricted to research protocols.…”

Section: Innovative Technologies and Processesmentioning

confidence: 99%

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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Ability of ICU Health-Care Professionals to Identify Patient-Ventilator Asynchrony Using Waveform Analysis

Abstract: HCPs who have specific training in mechanical ventilation increase their ability to identify asynchrony using waveform analysis. Neither experience nor profession proved to be a relevant factor to identify asynchrony correctly using waveform analysis.

Cited by 58 publications

References 16 publications

Identifying Patient-Ventilator Asynchrony Using Waveform Analysis

Identifying Patient-Ventilator Asynchrony Using Waveform Analysis

Patient-Ventilator Asynchrony and Standard Waveforms: Looks Can Be Deceiving

Patient-ventilator asynchrony

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