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Patient-ventilator asynchrony in a traumatically injured population.
Bryce Rh Robinson1, Thomas C Blakeman, Peter Toth
1Division of Trauma and Critical Care, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Respiratory Care
|March 21, 2013
Summary
Patient-ventilator asynchrony is common in trauma patients, particularly with synchronized intermittent mandatory ventilation (SIMV) set at ≥ 10 breaths/min. This study found no association with longer ventilation, hospital stay, or discharge outcomes.
Area of Science:
- Critical Care Medicine
- Respiratory Therapy
- Trauma Surgery
Background:
- Patient-ventilator asynchrony is linked to adverse outcomes in medical patients, including prolonged ventilation and hospital stays.
- However, the prevalence and impact of asynchrony remain poorly defined in traumatically injured populations.
Purpose of the Study:
- To investigate the occurrence and characteristics of patient-ventilator asynchrony in mechanically ventilated trauma patients.
- To explore potential associations between asynchrony and ventilator settings, patient demographics, and clinical outcomes.
Main Methods:
- Breath waveforms were analyzed in 35 mechanically ventilated trauma patients within 48 hours of intubation.
- Asynchrony was defined by specific breath patterns (e.g., ineffective triggering, double-triggering).
- Demographic, injury severity, sedation, and clinical outcomes were prospectively collected.
Main Results:
- Asynchrony was identified in 25.7% of subjects.
- Asynchronous patients more frequently used synchronized intermittent mandatory ventilation (SIMV) (100% vs. 38.5%) and had fewer spontaneous breaths per minute.
- SIMV with a set frequency of ≥ 10 breaths/min was associated with higher asynchrony rates (P = .02).
Conclusions:
- Patient-ventilator asynchrony is prevalent in trauma patients.
- Asynchrony may be linked to specific SIMV settings but did not correlate with prolonged mechanical ventilation, hospital stay, or discharge disposition in this cohort.
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