Patient-ventilator asynchrony during conventional mechanical ventilation in children

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Guillaume Mortamet1,2,3, Alexandrine Larouche1,3, Laurence Ducharme-Crevier1,3

  • 1Pediatric Intensive Care Unit, CHU Sainte-Justine, 3175 Côte Sainte-Catherine, Montreal, QC, Canada.

Annals of Intensive Care
|December 22, 2017
PubMed

Insights

Critically ill children on mechanical ventilation often experience significant patient-ventilator asynchrony, impacting their breathing patterns. Improving this interaction is crucial for better outcomes in pediatric critical care.

Area of Science:

  • Pediatric Critical Care Medicine
  • Respiratory Physiology
  • Mechanical Ventilation

Background:

  • Patient-ventilator asynchrony is a common challenge in critically ill children.
  • Understanding its characteristics and risk factors is essential for optimizing respiratory support.

Purpose of the Study:

  • To characterize patient-ventilator asynchrony in pediatric intensive care unit (PICU) patients.
  • To identify risk factors for asynchrony.
  • To assess the association between asynchrony and ventilator-free days.

Main Methods:

  • Prospective, single-center study of mechanically ventilated children (≥24 hours).
  • Analysis of patient-ventilator asynchrony using ventilator pressure curves and electrical activity of the diaphragm (Edi).
  • Comparison of manual analysis with a fully automated algorithm (NeuroSync index).

Main Results:

  • Fifty-two children were analyzed; 18 had insufficient ventilatory drive for asynchrony calculation.
  • Children spent 27% of ventilation time in asynchrony, primarily due to cycling-off errors and trigger delays.
  • A high prevalence of asynchrony was confirmed (NeuroSync index 45%); no association with ventilator-free days was found.

Conclusions:

  • Conventional mechanical ventilation in children is associated with poor patient-ventilator interaction.
  • Depressed ventilatory drive and significant asynchrony are frequent.
  • Further research is needed to evaluate strategies for improving patient-ventilator synchrony in pediatric critical care.
Abstract

Keywords:
Diaphragm functionMechanical ventilationPatient–ventilator asynchronyPatient–ventilator interactionPediatric intensive care unitPediatrics

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