No harm, no benefit: should we give up with neurally adjusted ventilatory assist?

Navalesi, Paolo; Longhini, Federico

doi:10.1007/s00134-016-4484-3

Cited by 2 publications

(2 citation statements)

References 10 publications

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“…From Thille's study [20], 10% or more was marked as a cutoff point because it was associated with worse clinical outcomes. This reference parameter was adopted in the other studies on patient-ventilator asynchrony [40,[44][45][46][47][48][49][50].The fact that the highest incidence of total AI of 10% or higher occurs in VCV ventilation may be related to the characteristic of the mode that promotes constant volume delivery, in contrast to the physiological process, in which the inspired volume varies with every breath. Many asynchronies probably occurred when the volume delivered was not adequate for the need in certain cycles, whereas in PCV these moments were less frequent because the volume varies accordingly to the respiratory mechanics [45,46].…”

Section: Asynchrony Index -Severity Indicatormentioning

confidence: 99%

“…Patients submitted to low parameters may not have their metabolic needs attended to during this phase of assessing their readiness for extubation [47]. With underassistance of ventilation, patients are forced to increase their respiratory work and lung volumes, consequently they present a greater magnitude of asynchrony, among them double triggering and associated stacking [48].…”

Section: Asynchrony Index -Severity Indicatormentioning

confidence: 99%

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Patient-ventilator asynchrony in conventional ventilation modes during short-term mechanical ventilation after cardiac surgery: randomized clinical trial

et al. 2020

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Introduction and aim: Studies regarding asynchrony in patients in the cardiac postoperative period are still only a few. The main objective of our study was to compare asynchronies incidence and its index (AI) in 3 different modes of ventilation (volume-controlled ventilation [VCV], pressure-controlled ventilation [PCV] and pressure-support ventilation [PSV]) after ICU admission for postoperative care. Methods: A prospective parallel randomised trial in the setting of a non-profitable hospital in Brazil. The participants were patients scheduled for cardiac surgery. Patients were randomly allocated to VCV or PCV modes of ventilation and later both groups were transitioned to PSV mode. Results: All data were recorded for 5 minutes in each of the three different phases: T1) in assisted breath, T2) initial spontaneous breath and T3) final spontaneous breath, a marking point prior to extubation. Asynchronies were detected and counted by visual inspection method by two independent investigators. Reliability, inter-rater agreement of asynchronies, asynchronies incidence, total and specific asynchrony indexes (AIt and AIspecific) and odds of AI ≥10% weighted by total asynchrony were analysed. A total of 17 patients randomly allocated to the VCV (n= 9) or PCV (n=8) group completed the study. High inter-rated agreement for AIt (ICC 0.978; IC95%, 0,963-0.987) and good reliability (r=0.945; p<0.001) were found. Eighty-two % of patients presented asynchronies, although only 7% of their total breathing cycles were asynchronous. Early cycling and double triggering had the highest rates of asynchrony with no difference between groups. The highest odds of AI ≥10% were observed in VCV regardless the phase: OR 2.79 (1.36-5.73) in T1 vs T2, p=0.005; OR 2.61 (1.27-5.37) in T1 vs T3, p=0.009 and OR 4.99 (2.37-10.37) in T2 vs T3, p<0.001. Conclusions: There was a high incidence of breathing asynchrony in postoperative cardiac patients, especially when initially ventilated in VCV. VCV group had a higher chance of AI ≥10% and this chance remained high in the following PSV phases.

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Section: Asynchrony Index -Severity Indicatormentioning

confidence: 99%

Section: Asynchrony Index -Severity Indicatormentioning

confidence: 99%

Patient-ventilator asynchrony in conventional ventilation modes during short-term mechanical ventilation after cardiac surgery: randomized clinical trial

et al. 2020

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Recognizing, quantifying and managing patient-ventilator asynchrony in invasive and noninvasive ventilation

Garofalo

Bruni

Pelaia

et al. 2018

Expert Review of Respiratory Medicine

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Patient-ventilator asynchrony may occur with modes of partial ventilatory support. Because this problem is associated with worsened outcomes, identifying and managing asynchronies has been recognized as a relevant clinical problem during both invasive and noninvasive (NIV) mechanical ventilation. Areas covered: In this review article, we first describe the different forms of patient-ventilator asynchrony and how they are classified and quantified. Then, we show how these asynchronies can be recognized, considering the techniques used to properly detect asynchronies, by either ventilator waveform observation, or through systems based on more complexes mathematical algorithms, by means of adjunctive signals, such as the electrical activity of the diaphragm or esophageal pressure. Finally, we describe the actions that can be undertaken in order to limit the rate of asynchronies during both invasive ventilation and NIV mechanical ventilation, such as modifications of the ventilator mode and/or settings, variation of the sedation regimen (type and doses), and other technical pitfalls. Expert commentary: Detection of asynchronies is crucial in order to reduce their incidence, adopting adjustments of the ventilator settings, sedation regimen, and other technical pitfalls. It remains to be clarified whether the relationship between high incidence of asynchrony and worsened outcome is causative or just associative.

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No harm, no benefit: should we give up with neurally adjusted ventilatory assist?

Cited by 2 publications

References 10 publications

Patient-ventilator asynchrony in conventional ventilation modes during short-term mechanical ventilation after cardiac surgery: randomized clinical trial

Patient-ventilator asynchrony in conventional ventilation modes during short-term mechanical ventilation after cardiac surgery: randomized clinical trial

Recognizing, quantifying and managing patient-ventilator asynchrony in invasive and noninvasive ventilation

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