Patient-ventilator asynchrony

Sassoon, Catherine S. H.; Foster, Guy T.

doi:10.1097/00075198-200102000-00005

Cited by 101 publications

(88 citation statements)

References 20 publications

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“…Of particular importance is the ability of the device to allow easy initiation of gas flow and expiration without undue resistance, because asynchrony in either instance increases work of breathing. 34,35 An early study by Hess et al 36 evaluated the inspiratory and expiratory imposed work of breathing and oxygen delivery of 11 manual resuscitators. A 2-chambered test lung driven by a mechanical ventilator delivered low, moderate, and high ventilatory patterns.…”

Section: Spontaneous Breathing During Transportmentioning

confidence: 99%

Should a Portable Ventilator Be Used in All In-Hospital Transports?

Holets

Davies

2016

Respir Care

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Movement of the mechanically ventilated patient may be for a routine procedure or medical emergency. The risks of transport seem manageable, but the memory of a respiratory-related catastrophe still gives many practitioners pause. The risk/benefit ratio of transport must be assessed before movement. During transport of the ventilated patients, should we always use a transport ventilator? What is the risk of using manual ventilation? How are PEEP and F IO 2 altered? Is there an impact on the ability to trigger during manual ventilation? Is hyperventilation and hypoventilation a common problem? Does hyperventilation or hypoventilation result in complications? Are portable ventilators worth the cost? What about the function of portable ventilators? Can these devices faithfully reproduce ICU ventilator function? The following pro and con discussion will attempt to address many of these issues by reviewing the current evidence on transport ventilation.

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Section: Spontaneous Breathing During Transportmentioning

confidence: 99%

Should a Portable Ventilator Be Used in All In-Hospital Transports?

Holets

Davies

2016

Respir Care

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“…PVD increases the duration of mechanical ventilation and consequently the tracheostomy rate. 1,4 PVD has also been implicated in respiratory muscle injury. 1,4,5 Ineffective inspiratory efforts during expiration (IEE) and double triggering are the most common types of PVD.…”

Section: Subjectsmentioning

confidence: 99%

“…1,4 PVD has also been implicated in respiratory muscle injury. 1,4,5 Ineffective inspiratory efforts during expiration (IEE) and double triggering are the most common types of PVD. 1,6 An IEE is defined as activation of inspiratory muscles without triggering of the ventilator.…”

Section: Subjectsmentioning

confidence: 99%

Nurses' Detection of Ineffective Inspiratory Efforts During Mechanical Ventilation

Chacon¹,

Estruga²,

Murias³

et al. 2012

American Journal of Critical Care

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Background Patient-ventilator dyssynchrony is common and may influence patients' outcomes. Detection of such dyssynchronies relies on careful observation of patients and airway flow and pressure measurements. Given the shortage of specialists, critical care nurses could be trained to identify dyssynchronies. Objective To evaluate the accuracy of specifically trained critical care nurses in detecting ineffective inspiratory efforts during expiration. Methods We compared 2 nurses' evaluations of measurements from 1007 breaths in 8 patients with the evaluations of experienced critical care physicians. Sensitivity, specificity, positive predictive value, negative predictive value, and the Cohen κ for interobserver agreement were calculated. Results For the first nurse, sensitivity was 92.5%, specificity was 98.3%, positive predictive value was 95.4%, negative predictive value was 97.1%, and κ was 0.92 (95% CI, 0.89-0.94). For the second nurse, sensitivity was 98.5%, specificity was 84.7%, positive predictive value was 70.7%, negative predictive value was 99.3%, and κ was 0.74 (95% CI, 0.70-0.78). Conclusion Specifically trained nurses can reliably detect ineffective inspiratory efforts during expiration.

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“…Therefore we refer the reader to other excellent reviews. 4,9,10 Basically, from a physiological point of view, patient-ventilator asynchrony may be divided into timing asynchrony and flow assist asynchrony.…”

Section: Patient-ventilator Asynchronymentioning

confidence: 99%

“…3,4 Patient-ventilator asynchrony can be attributed to pathological patient-related factors and to technical factors (inappropriate ventilator settings or technical defect of the ventilator). 9,10 The main patient-related determinant of substantial patient-ventilator asynchrony during assisted ventilation modes is the presence of intrinsic PEEP and dynamic hyperinflation. The latter, as commonly observed in patients with COPD, leads to a shortening of the inspiratory muscles, with a reduced apposition zone of the respiratory muscle and a more horizontal position of the diaphragm.…”

Section: The Importance Of Patient-ventilator Synchronymentioning

confidence: 99%

Neurally Adjusted Ventilatory Assist: A Ventilation Tool or a Ventilation Toy?

Verbrugghe

Jorens

2011

Respir Care

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Mechanical ventilation has, since its introduction into clinical practice, undergone a major evolution from controlled ventilation to various modes of assisted ventilation. Neurally adjusted ventilatory assist (NAVA) is the newest development. The implementation of NAVA requires the introduction of a catheter to measure the electrical activity of the diaphragm (EA di ). NAVA relies, opposite to conventional assisted ventilation modes, on the EA di to trigger the ventilator breath and to adjust the ventilatory assist to the neural drive. The amplitude of the ventilator assist is determined by the instantaneous EA di and the NAVA level set by the clinician. The NAVA level amplifies the EA di signal and determines instantaneous ventilator assist on a breath-to-breath basis. Experimental and clinical data suggest superior patient-ventilator synchrony with NAVA. Patient-ventilator asynchrony is present in 25% of mechanically ventilated patients in the intensive care unit and may contribute to patient discomfort, sleep fragmentation, higher use of sedation, development of delirium, ventilator-induced lung injury, prolonged mechanical ventilation, and ultimately mortality. With NAVA, the reliance on the EA di signal, together with an intact ventilatory drive and intact breathing reflexes, allows integration of the ventilator in the neuro-ventilatory coupling on a higher level than conventional ventilation modes. The simple monitoring of the EA di signal alone may provide the clinician with important information to guide ventilator management, especially during the weaning process. Although, until now, little evidence proves the superiority of NAVA on clinically relevant end points, it seems evident that patient populations (eg, COPD and small children) with major patient-ventilator asynchrony may benefit from this new ventilatory tool.

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Patient-ventilator asynchrony

Cited by 101 publications

References 20 publications

Should a Portable Ventilator Be Used in All In-Hospital Transports?

Should a Portable Ventilator Be Used in All In-Hospital Transports?

Nurses' Detection of Ineffective Inspiratory Efforts During Mechanical Ventilation

Neurally Adjusted Ventilatory Assist: A Ventilation Tool or a Ventilation Toy?

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