Patient-ventilator asynchrony

Murias, Tiberio Feliz; Lucangelo, Umberto; Blanch, Lluís

doi:10.1097/mcc.0000000000000270

Cited by 60 publications

(38 citation statements)

References 28 publications

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“…Additionally, the EIP prolongation increases the mechanical inflation time and it could extend into neural expiration. Asynchronies may thus develop and cause an inadequate patient–ventilator interaction when the patients are not paralyzed [39–41]. Our results could be dependent on our routine management of mechanical ventilation in ARDS patients, but our findings have been consistent in all patients and we consider they could be extrapolated to other ARDS patients.…”

Section: Discussionmentioning

confidence: 64%

End-inspiratory pause prolongation in acute respiratory distress syndrome patients: effects on gas exchange and mechanics

Aguirre-Bermeo

Morán

Bottiroli

et al. 2016

Ann. Intensive Care

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BackgroundEnd-inspiratory pause (EIP) prolongation decreases dead space-to-tidal volume ratio (Vd/Vt) and PaCO2. We do not know the physiological benefits of this approach to improve respiratory system mechanics in acute respiratory distress syndrome (ARDS) patients when mild hypercapnia is of no concern.MethodsThe investigation was conducted in an intensive care unit of a university hospital, and 13 ARDS patients were included. The study was designed in three phases. First phase, baseline measurements were taken. Second phase, the EIP was prolonged until one of the following was achieved: (1) EIP of 0.7 s; (2) intrinsic positive end-expiratory pressure ≥1 cmH2O; or (3) inspiratory–expiratory ratio 1:1. Third phase, the Vt was decreased (30 mL every 30 min) until PaCO2 equal to baseline was reached. FiO2, PEEP, airflow and respiratory rate were kept constant.ResultsEIP was prolonged from 0.12 ± 0.04 to 0.7 s in all patients. This decreased the Vd/Vt and PaCO2 (0.70 ± 0.07 to 0.64 ± 0.08, p < 0.001 and 54 ± 9 to 50 ± 8 mmHg, p = 0.001, respectively). In the third phase, the decrease in Vt (from 6.3 ± 0.8 to 5.6 ± 0.8 mL/Kg PBW, p < 0.001) allowed to decrease plateau pressure and driving pressure (24 ± 3 to 22 ± 3 cmH2O, p < 0.001 and 13.4 ± 3.6 to 10.9 ± 3.1 cmH2O, p < 0.001, respectively) and increased respiratory system compliance from 29 ± 9 to 32 ± 11 mL/cmH2O (p = 0.001). PaO2 did not significantly change.ConclusionsProlonging EIP allowed a significant decrease in Vt without changes in PaCO2 in passively ventilated ARDS patients. This produced a significant decrease in plateau pressure and driving pressure and significantly increased respiratory system compliance, which suggests less overdistension and less dynamic strain.

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Section: Discussionmentioning

confidence: 64%

End-inspiratory pause prolongation in acute respiratory distress syndrome patients: effects on gas exchange and mechanics

Aguirre-Bermeo

Morán

Bottiroli

et al. 2016

Ann. Intensive Care

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“…There is some evidence that sedation has an important role in PVAs (Epstein, 2011). One of the indications for sedation is to facilitate patient-ventilator interaction (Murias, Lucangelo, and Blanch, 2016). Sedation decreases inspiratory muscle effort and lowers maximal inspiratory flow, so the patient may appear calmer; nevertheless, asynchronies may persist and there is a high probability that they are under diagnosed (de Wit, Pedram, Best, & Epstein, 2009;Vaschetto et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

Bayesian joint modeling of bivariate longitudinal and competing risks data: An application to study patient‐ventilator asynchronies in critical care patients

et al. 2017

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Mechanical ventilation is a common procedure of life support in intensive care. Patient-ventilator asynchronies (PVAs) occur when the timing of the ventilator cycle is not simultaneous with the timing of the patient respiratory cycle. The association between severity markers and the events death or alive discharge has been acknowledged before, however, little is known about the addition of PVAs data to the analyses. We used an index of asynchronies (AI) to measure PVAs and the SOFA (sequential organ failure assessment) score to assess overall severity. To investigate the added value of including the AI, we propose a Bayesian joint model of bivariate longitudinal and competing risks data. The longitudinal process includes a mixed effects model for the SOFA score and a mixed effects beta regression model for the AI. The survival process is defined in terms of a cause-specific hazards model for the competing risks death or alive discharge. Our model indicates that the SOFA score is strongly related to vital status. PVAs are positively associated with alive discharge but there is not enough evidence that PVAs provide a more accurate indication of death prognosis than the SOFA score alone.

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“…The first is the optimization of the ventilatory settings to improve lung recruitment [67] using PEEP titration methods one of which is electrical impedance tomography [68]. Mechanical ventilation asynchronies occur often during invasive mechanical ventilation [69]. Once detected, however, a crucial question is how to improve patient-ventilator interaction.…”

Section: Supportive Treatment Including Ecmomentioning

confidence: 99%

Severe flu management: a point of view

et al. 2020

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Annual flu seasons are typically characterized by changes in types and subtypes of influenza, with variations in terms of severity. Despite remarkable improvements in the prevention and management of patients with suspected or laboratory-confirmed diagnosis of influenza, annual seasonal influenza continues to be associated with a high morbidity and mortality. Admission to the intensive care unit is required for patients with severe forms of seasonal influenza infection, with primary pneumonia being present in most of the cases. This review summarizes the most recent knowledge on the diagnosis and treatment strategies in critically ill patients with influenza, focused on diagnostic testing methods, antiviral therapy, use of corticosteroids, antibacterial and antifungal therapy, and supportive measures. The review focuses on diagnostic testing methods, antiviral therapy, use of corticosteroids, antibacterial and antifungal therapy, supportive measures and relevant existing evidence, in order to provide the non-expert clinician a useful overview. An enhanced understanding of current diagnostic and treatment aspects of influenza infection can contribute to improve outcomes and reduce mortality among ICU patients with influenza.

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Patient-ventilator asynchrony

Cited by 60 publications

References 28 publications

End-inspiratory pause prolongation in acute respiratory distress syndrome patients: effects on gas exchange and mechanics

End-inspiratory pause prolongation in acute respiratory distress syndrome patients: effects on gas exchange and mechanics

Bayesian joint modeling of bivariate longitudinal and competing risks data: An application to study patient‐ventilator asynchronies in critical care patients

Severe flu management: a point of view

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