Clusters of ineffective efforts during mechanical ventilation: impact on outcome

Vaporidi, Katerina; Babalis, Dimitris; Chytas, Achilleas; Lilitsis, Emmanuel; Kondili, Eumorfia; Amargianitakis, Vasilis; Chouvarda, Ioanna; Maglaveras, Nicos; Georgopoulos, Dimitris

doi:10.1007/s00134-016-4593-z

Cited by 122 publications

(117 citation statements)

References 24 publications

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“…3 Asynchronies are common throughout mechanical ventilation, occur in all mechanical ventilation modes, and might be associated with outcome, 4 especially when they occur in clusters. 5 This review discusses the different types of asynchronies and how they are generated, their impact on patient comfort and outcome, and practical approaches for detecting, correcting, and preventing them.…”

Section: Introductionmentioning

confidence: 99%

Minimizing Asynchronies in Mechanical Ventilation: Current and Future Trends

et al. 2018

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Patient-ventilator asynchrony exists when the phases of breath delivered by the ventilator do not match those of the patient. Asynchronies occur throughout mechanical ventilation and negatively affect patient comfort, duration of mechanical ventilation, length of ICU stays, and mortality. Identifying asynchronies requires careful attention to patients and their ventilator waveforms. This review discusses the different types of asynchronies, how they are generated, and their impact on patient comfort and outcome. Moreover, it discusses practical approaches for detecting, correcting, and preventing asynchronies. Current evidence suggests that the best approach to managing asynchronies is by adjusting ventilator settings. Proportional modes improve patient-ventilator coupling, resulting in greater comfort and less dyspnea, but not in improved outcomes with respect to the duration of mechanical ventilation, delirium, or cognitive impairment. Advanced computational technologies will allow smart alerts, and models based on time series of asynchronies will be able to predict and prevent asynchronies, making it possible to tailor mechanical ventilation to meet each patient's needs throughout the course of mechanical ventilation.

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Section: Introductionmentioning

confidence: 99%

Minimizing Asynchronies in Mechanical Ventilation: Current and Future Trends

et al. 2018

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“…Patient-ventilator asynchrony can be defined as a mismatch between the neural inspiratory time and ventilator inspiratory time [63]. Patient-ventilator asynchrony is associated with worse outcome [64] and occurs in up to half of mechanically ventilated patients. Visual inspection of the airway flow and pressure signal may detect asynchrony, but was shown to be unreliable [65].…”

Section: Role Of Respiratory Muscle Ultrasound To Assess Patientventimentioning

confidence: 99%

Respiratory muscle ultrasonography: methodology, basic and advanced principles and clinical applications in ICU and ED patients—a narrative review

et al. 2020

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Respiratory muscle ultrasound is used to evaluate the anatomy and function of the respiratory muscle pump. It is a safe, repeatable, accurate, and non-invasive bedside technique that can be successfully applied in different settings, including general intensive care and the emergency department. Mastery of this technique allows the intensivist to rapidly diagnose and assess respiratory muscle dysfunction in critically ill patients and in patients with unexplained dyspnea. Furthermore, it can be used to assess patient-ventilator interaction and weaning failure in critically ill patients. This paper provides an overview of the basic and advanced principles underlying respiratory muscle ultrasound with an emphasis on the diaphragm. We review different ultrasound techniques useful for monitoring of the respiratory muscle pump and possible therapeutic consequences. Ideally, respiratory muscle ultrasound is used in conjunction with other components of critical care ultrasound to obtain a comprehensive evaluation of the critically ill patient. We propose the ABCDE-ultrasound approach, a systematic ultrasound evaluation of the heart, lungs and respiratory muscle pump, in patients with weaning failure.

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“…As shown in the ICU setting,2 it is possible that detection and quantification of PVA according to this algorithm underestimates the number of events.…”

Section: Discussionmentioning

confidence: 99%

“…Previous papers from our SomnoNIV group1 suggested a systematic approach for monitoring nocturnal NIV and summarised the semiology of undesired events detected by polygraphy (PG) performed under NIV 1. Patient-ventilator asynchrony (PVA) under NIV was not emphasised in these publications, although it has been extensively described in intensive care unit (ICU) patients, with its clinical consequences 2. Over the past 10 years, PVA has also been reported in a small number of studies performed on chronic NIV patients, using polygraphic assessment 3–5.…”

Section: Introductionmentioning

confidence: 99%

Framework for patient-ventilator asynchrony during long-term non-invasive ventilation

Gonzalez-Bermejo

Janssens

Rabec

et al. 2019

Thorax

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Episodes of patient-ventilator asynchrony (PVA) occur during acute and chronic non-invasive positive pressure ventilation (NIV). In long-term NIV, description and quantification of PVA is not standardised, thus limiting assessment of its clinical impact. The present report provides a framework for a systematic analysis of polygraphic recordings of patients under NIV for the detection and classification of PVA validated by bench testing. The algorithm described uses two different time windows: rate asynchrony and intracycle asynchrony. This approach should facilitate further studies on prevalence and clinical impact of PVA in long-term NIV.

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Clusters of ineffective efforts during mechanical ventilation: impact on outcome

Abstract: Clusters of IEs are often present in mechanically ventilated critically ill patients and are associated with prolonged mechanical ventilation and increased mortality. Studies to find ways of improving patient-ventilator interaction are warranted.

Cited by 122 publications

References 24 publications

Minimizing Asynchronies in Mechanical Ventilation: Current and Future Trends

Minimizing Asynchronies in Mechanical Ventilation: Current and Future Trends

Respiratory muscle ultrasonography: methodology, basic and advanced principles and clinical applications in ICU and ED patients—a narrative review

Framework for patient-ventilator asynchrony during long-term non-invasive ventilation

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