Patient–ventilator asynchrony during non-invasive ventilation for acute respiratory failure: a multicenter study

Vignaux, Laurence; Vargas, Frédéric; Roeseler, Jean; Tassaux, Didier; Thille, Arnaud W.; Kossowsky, Michel P.; Brochard, Laurent; Jolliet, Philippe

doi:10.1007/s00134-009-1416-5

Cited by 282 publications

(268 citation statements)

References 29 publications

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“…Second, as the presence of a nasogastric tube can potentially worsen leaks, this could theoretically have adversely influenced patient-ventilator synchrony during PS. However, in our patients, leak volume during PS (2.9 ± 3 l/min) was lower than previously reported values for PS-NIV [6,9], despite the presence of NAVA nasogastric tubes. Third, since during PS-NIV settings were defined by the clinicians according to their usual procedures, the optimization of expiratory trigger, PSlevel and pressurization ramp can be questioned.…”

Section: Discussioncontrasting

confidence: 82%

“…This could potentially have increased the beneficial effect of NAVA on patientventilator synchrony as compared to PS-NIV. However, as shown in a previous study, NIV modes do not succeed in reducing the total number of patient-ventilator asynchronies [6]. Second, as the presence of a nasogastric tube can potentially worsen leaks, this could theoretically have adversely influenced patient-ventilator synchrony during PS.…”

Section: Discussionmentioning

confidence: 80%

“…They are particularly frequent during PS-NIV because unavoidable leaks at the patient-ventilator interface interfere with pneumatic triggering (i.e. pressure or flow triggering) and cycling-off [6]. As asynchronies are related to poor tolerance and increased risk of NIV failure [7], reducing asynchronies during NIV is a major issue.…”

Section: Introductionmentioning

confidence: 99%

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Neurally adjusted ventilatory assist (NAVA) improves patient–ventilator interaction during non-invasive ventilation delivered by face mask

Piquilloud

Tassaux

Bialais³

et al. 2012

Intensive Care Med

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Purpose: To determine if, compared to pressure support (PS), neurally adjusted ventilatory assist (NAVA) reduces patient-ventilator asynchrony in intensive care patients undergoing noninvasive ventilation with an oronasal face mask. Methods: In this prospective interventional study we compared patient-ventilator synchrony between PS (with ventilator settings determined by the clinician) and NAVA (with the level set so as to obtain the same maximal airway pressure as in PS). Two 20-min recordings of airway pressure, flow and electrical activity of the diaphragm during PS and NAVA were acquired in a randomized order. Trigger delay (T d ), the patient's neural inspiratory time (T in ), ventilator pressurization duration (T iv ), inspiratory time in excess (T iex ), number of asynchrony events per minute and asynchrony index (AI) were determined. Results: The study included 13 patients, six with COPD, and two with mixed pulmonary disease. T d was reduced with NAVA: median 35 ms (IQR 31-53 ms) versus 181 ms (122-208 ms); p = 0.0002. NAVA reduced both premature and delayed cyclings in the majority of patients, but not the median T iex value. The total number of asynchrony events tended to be reduced with NAVA: 1.0 events/min (0.5-3.1 events/min) versus 4.4 events/min (0.9-12.1 events/min); p = 0.08. AI was lower with NAVA: 4.9 % (2.5-10.5 %) versus 15.8 % (5.5-49.6 %); p = 0.03. During NAVA, there were no ineffective efforts, or late or premature cyclings. PaO 2 and PaCO 2 were not different between ventilatory modes. Conclusion: Compared to PS, NAVA improved patient ventilator synchrony during noninvasive ventilation by reducing T d and AI. Moreover, with NAVA, ineffective efforts, and late and premature cyclings were absent.

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Section: Discussioncontrasting

confidence: 82%

Section: Discussionmentioning

confidence: 80%

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Neurally adjusted ventilatory assist (NAVA) improves patient–ventilator interaction during non-invasive ventilation delivered by face mask

Piquilloud

Tassaux

Bialais³

et al. 2012

Intensive Care Med

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“…Raising cycling in our study reduced asynchrony to zero and significantly reduced PEEPi. 20,21 This is consistent with previously published data that showed reduced wasted efforts with conventional set cycling (25% peak flow) 22,23 compared with a higher incidence of non-supported inspiratory effort with short expiration time and …”

Section: Discussionsupporting

confidence: 91%

Patient-Ventilator Interaction During Noninvasive Ventilation in Simulated COPD

et al. 2015

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BACKGROUND: During noninvasive ventilation (NIV) of COPD patients, delayed off-cycling of pressure support can cause patient ventilator mismatch and NIV failure. This systematic experimental study analyzes the effects of varying cycling criteria on patient-ventilator interaction. METHODS: A lung simulator with COPD settings was connected to an ICU ventilator via helmet or face mask. Cycling was varied between 10 and 70% of peak inspiratory flow at different breathing frequencies (15 and 30 breaths/min) and pressure support levels (5 and 15 cm H 2 O) using the ventilator's invasive and NIV mode with and without an applied leakage. RESULTS: Low cycling criteria led to severe expiratory cycle latency. Augmenting off-cycling reduced expiratory cycle latency (P < .001), decreased intrinsic PEEP, and avoided non-supported breaths. Setting cycling to 50% of peak inspiratory flow achieved best synchronization. Overall, using the helmet interface increased expiratory cycle latency in almost all settings (P < .001). Augmenting cycling from 10 to 40% progressively decreased expiratory pressure load (P < .001). NIV mode decreased expiratory cycle latency compared with the invasive mode (P < .001). CONCLUSION: Augmenting the cycling criterion above the default setting (20 -30% peak inspiratory flow) improved patient ventilator synchrony in a simulated COPD model. This suggests that an individual approach to cycling should be considered, since interface, level of pressure support, breathing frequency, and leakage influence patient-ventilator interaction and thus need to be considered.

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“…Other studies have also suggested that major asynchrony, including IE, is associated with prolonged mechanical ventilation, unsuccessful weaning, sleep fragmentation, and discomfort [2,12,[18][19][20]. Finally, during noninvasive mechanical ventilation IE are related to nocturnal desaturation and reduced REM sleep [6,21].…”

mentioning

confidence: 99%

Ineffective efforts during mechanical ventilation: the brain wants, the machine declines

Georgopoulos

2012

Intensive Care Med

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Patient–ventilator asynchrony during non-invasive ventilation for acute respiratory failure: a multicenter study

Cited by 282 publications

References 29 publications

Neurally adjusted ventilatory assist (NAVA) improves patient–ventilator interaction during non-invasive ventilation delivered by face mask

Neurally adjusted ventilatory assist (NAVA) improves patient–ventilator interaction during non-invasive ventilation delivered by face mask

Patient-Ventilator Interaction During Noninvasive Ventilation in Simulated COPD

Ineffective efforts during mechanical ventilation: the brain wants, the machine declines

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