Patient-ventilator asynchronies are a mismatch between the inspiratory and expiratory times of the patient and the ventilator.
Complications
- Increased work of breathing
- Ineffective effort
- Air trapping
- Respiratory alkalosis and hyperinflation of the lungs (Auto-triggering)
- Dynamic Hyperinflation
- Auto PEEP (also known as intrinsic PEEP (PEEPi))
- Alters the outcome of Weaning
- Increased levels of sedation
- Confusion about the actual condition of the patient
- Sleep disorders
- Longer ICU stay and mechanical ventilation
Trigger asynchronies
- occurring during the beginning of inspiration
- Delayed-triggering
- time interval between inspiratory effort and the delivery of a mechanical breath is increased
- Ineffective effort:
- inspiratory effort fails to trigger mechanical breath delivery
- Auto-triggering:
- a mechanical breath is delivered without a patient inspiratory effort
Flow asynchronies
- occurring during the gas delivery
- Double-triggering:
- two (or more) mechanical breaths are delivered during one single inspiratory effort
- Flow asynchrony:
- delivered flow does not meet inspiratory flow demands
- Early cycling:
- mechanical breath duration is shorter than inspiratory effort duration
- Delayed cycling:
- mechanical breath duration is longer than inspiratory effort duration
References
- Arellano, D.H., Palliative Medicine & Care. 2017;4(4):1-6. DOI: 10.15226/2374-8362/4/4/00147
- Arnal, J.M., Monitoring Mechanical Ventilation Using Ventilator Waveforms, Springer International Publishing. 2018. ISBN: 9783319586540)
- Dres, M., Current opinion in critical care. April 2016;22(3):246-253. DOI: 10.1097/MCC.0000000000000307
- Holanda, M.A., Jornal Brasileiro de Pneumologia. 2018;44(4):321-333. DOI: 10.1590/S1806-37562017000000185
- Mellot, K.G., Critical Care Nurse. 2009 December; 29(6): 41–55. DOI: 10.4037/ccn2009612.