Patient ventilator asynchrony in critically ill adults: Frequency and types

• Published in: Heart & lung Vol. 43; no. 3; pp. 231 - 243
• Main Authors: Mellott, Karen G., PhD, RN, Grap, Mary Jo, PhD, RN, FAAN, Munro, Cindy L., PhD, RN, ANP-C, FAAN, Sessler, Curtis N., MD, FCCM, FCCP, Wetzel, Paul A., PhD, Nilsestuen, Jon O., PhD, RRT, FAARC, Ketchum, Jessica M., PhD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.05.2014; Elsevier Science Ltd
• Subjects: Artificial; Cardiovascular; Clinical outcomes; Critical Care; Critical Illness; Emotional disorders; Equipment Failure - statistics & numerical data; Female; Humans; Intensive Care Units; Male; Mechanical; Middle Aged; Monitoring, Physiologic; Patient ventilator asynchrony; Patient ventilator dyssynchrony; Patient ventilator interaction; Prospective Studies; Pulmonary/Respiratory; Respiration; Respiration, Artificial - instrumentation; Ventilators; Ventilators, Mechanical; Waveform analysis; ActDblTrig-PreTerm; New; ETT; Multiple Trigger; UnDblTrig; DblTrig-PreTerm; ActMultTrig-PreTerm; PreTerm-Flow; pressure control ventilation; intensive care unit; Patient Gasp PVA. PtGasp-PreTerm; Ventilators; Ineffective Trigger; legally authorized representative; Premature Termination; AI; MV; IQR; Patient Gasp; Endotracheal intubation; Non-invasive Cardiac Output; PSV; DblTrig; Patient ventilator dyssynchrony; Mechanical; PVA–Premature Termination; ActDblTrig; ResistVent; APACHE; PreTerm; Artificial; Multiple Trigger-Premature Termination; PCV; STICU; NICO; mechanical ventilation; MultTrig; PEEP; Unusual Double Trigger; positive end expiratory pressure; Double Trigger; interquartile range; DblTrig-Flow; IneffTrig; Surgical Trauma ICU; MRICU; Newly Described; pressure support ventilation; Double Trigger-Premature Termination; SIMV; Patient ventilator interaction; CSICU; Medical Respiratory ICU; Delayed Termination; Primary investigator; MultTrig-PreTerm; Synchronized Intermittent Mandatory Ventilation; DelTerm; Patient ventilator asynchrony; Acute Physiology, Age, Chronic Health Evaluation; Cardiac Surgery ICU; Resisting Ventilation; Active Multiple Trigger-Premature Termination; PtGasp; Active Double Trigger-Premature Termination; Double Trigger-Flow; PI; Chronic Obstructive Pulmonary Disease; ICU; Premature Termination-Flow; PVA; Asynchrony Index; Respiration; Active Double Trigger; LAR; COPD
• ISSN: 0147-9563; 1527-3288
• DOI: 10.1016/j.hrtlng.2014.02.002

Abstract Background Patient ventilator asynchrony (PVA) occurs frequently, but little is known about the types and frequency of PVA. Asynchrony is associated with significant patient discomfort, distress and poor clinical outcomes (duration of mechanical ventilation, intensive care unit and hospital stay). Methods Pressure–time and flow–time waveform data were collected on 27 ICU patients using the Noninvasive Cardiac Output monitor for up to 90 min per subject and blinded waveform analysis was performed. Results PVA occurred during all phases of ventilated breaths and all modes of ventilation. The most common type of PVA was Ineffective Trigger. Ineffective trigger occurs when the patient's own breath effort will not trigger a ventilator breath. The overall frequency of asynchronous breaths in the sample was 23%, however 93% of the sample experienced at least one incident of PVA during their observation period. Seventy-seven percent of subjects experienced multiple types of PVA. Conclusions PVA occurs frequently in a variety of types although the majority of PVA is ineffective trigger. The study uncovered previously unidentified waveforms that may indicate that there is a greater range of PVAs than previously reported. Newly described PVA, in particular, PVA combined in one breath, may signify substantial patient distress or poor physiological circumstance that clinicians should investigate.