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Asynchronies during mechanical ventilation are associated with mortality.

Lluís Blanch1, Ana Villagra, Bernat Sales

  • 1Critical Care Center, Hospital de Sabadell, Corporació Sanitaria Universitària Parc Taulí, Universitat Autònoma de Barcelona, Parc Taulí, 1, 08208, Sabadell, Spain, LBlanch@tauli.cat.

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Asynchronies during mechanical ventilation (MV) are common in all modes and patients, particularly during the day. While not affecting reintubation rates, high asynchrony levels correlate with increased mortality.

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Area of Science:

  • Critical Care Medicine
  • Respiratory Physiology

Background:

  • Mechanical ventilation (MV) is a life-support measure in intensive care units (ICUs).
  • Patient-ventilator asynchronies are common and can impact clinical outcomes.

Purpose of the Study:

  • To assess the prevalence and temporal patterns of asynchronies during MV.
  • To identify the types and frequency of specific asynchronies.

Main Methods:

  • Prospective observational study of 50 ICU patients on MV.
  • Utilized Better Care™ software to detect and quantify asynchronies (e.g., ineffective inspiratory efforts, double-triggering).
  • Analyzed 7,027 hours and over 8.7 million breaths to compute the asynchrony index (AI).

Main Results:

  • Asynchronies occurred in all patients and ventilatory modes, with a median AI of 3.41%.
  • Ineffective inspiratory efforts during expiration (IEE) was the most frequent asynchrony.
  • Asynchronies were less common during nighttime hours (12 AM to 6 AM).
  • Higher AI (>10%) was associated with increased ICU/hospital mortality and a trend toward longer MV duration.

Conclusions:

  • Asynchronies are a frequent occurrence throughout mechanical ventilation, irrespective of the mode.
  • The prevalence of asynchronies varies over a 24-hour period, being higher during daytime.
  • Further research is needed to clarify if asynchronies are a cause or merely a marker of mortality.