Recognizing, quantifying and managing patient-ventilator asynchrony in invasive and noninvasive ventilation

Area of Science:

• Critical Care Medicine
• Respiratory Therapy
• Pulmonary Medicine

Background:

• Patient-ventilator asynchrony is a recognized clinical problem in mechanical ventilation.
• Asynchrony is associated with adverse patient outcomes, necessitating effective management strategies.
• This issue is relevant in both invasive and noninvasive ventilation (NIV).

Purpose of the Study:

• To review the different forms, classification, and quantification of patient-ventilator asynchrony.
• To describe methods for detecting asynchronies using ventilator waveforms and advanced monitoring techniques.
• To outline strategies for reducing asynchrony during mechanical ventilation.

Main Methods:

• Review of existing literature on patient-ventilator asynchrony.
• Description of asynchrony classification and quantification methods.
• Discussion of detection techniques including waveform analysis, electrical activity of the diaphragm, and esophageal pressure monitoring.
• Analysis of management strategies such as ventilator setting adjustments, sedation modifications, and addressing technical issues.

Main Results:

• Patient-ventilator asynchrony manifests in various forms, requiring specific detection and quantification methods.
• Detection can be achieved through direct waveform observation or advanced algorithms using adjunctive signals.
• Management involves optimizing ventilator settings, adjusting sedation, and resolving technical problems.

Conclusions:

• Identifying and managing patient-ventilator asynchrony is crucial for improving outcomes in patients receiving mechanical ventilation.
• Adjustments to ventilator settings and sedation regimens can reduce asynchrony incidence.
• Further research is needed to determine if the association between high asynchrony incidence and worsened outcomes is causal.