Patient-ventilator asynchronies during mechanical ventilation: current knowledge and research priorities

Area of Science:

• Critical care medicine
• Respiratory physiology
• Biomedical engineering

Background:

• Mechanical ventilation is a life-saving treatment for critically ill patients but can lead to complications.
• Patient-ventilator asynchronies (PVAs) are frequent, underdiagnosed, and linked to adverse outcomes.
• PVAs occur when ventilator support mismatches patient's respiratory effort, causing under- or over-assistance.

Purpose of the Study:

• To review the current understanding of patient-ventilator asynchronies.
• To discuss the impact of PVAs on respiratory mechanics, hemodynamics, and psychological well-being.
• To highlight the potential of big data and advanced monitoring for improving PVA detection and management.

Main Methods:

• Review of existing literature on patient-ventilator interactions.
• Analysis of physiological effects of different types of asynchronies.
• Discussion of emerging technologies for monitoring and data analysis in critical care.

Main Results:

• Under-assistance can cause excessive respiratory muscle load and lung injury.
• Over-assistance may lead to reduced patient inspiratory drive and reverse triggering, worsening lung injury.
• PVAs can alter hemodynamic parameters and exacerbate patient anxiety and distress.
• Current evidence suggests an association between PVAs and worse prognosis, but direct causality requires further demonstration.

Conclusions:

• Despite advancements, significant knowledge gaps regarding PVAs persist.
• Further research is needed to address evolving concepts, organ interactions, and data management challenges.
• Improved understanding and management of PVAs are essential for optimizing mechanical ventilation strategies.