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The effects of real-time waveform analysis software on patient ventilator synchronization during pressure support

Barnpot Nakornnoi¹, Jamsak Tscheikuna¹, Nuttapol Rittayamai²

¹Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

BMC Pulmonary Medicine

|May 1, 2024

Abstract

Background:

Patient-ventilator asynchrony commonly occurs during pressure support ventilation (PSV). IntelliSync + software (Hamilton Medical AG, Bonaduz, Switzerland) is a new ventilation technology that continuously analyzes ventilator waveforms to detect the beginning and end of patient inspiration in real time. This study aimed to evaluate the physiological effect of IntelliSync + software on inspiratory trigger delay time, delta airway (P_aw) and esophageal (P_es) pressure drop during the trigger phase, airway occlusion pressure at 0.1 s (P_0.1), and hemodynamic variables.

Methods:

A randomized crossover physiologic study was conducted in 14 mechanically ventilated patients under PSV. Patients were randomly assigned to receive conventional flow trigger and cycling, inspiratory trigger synchronization (I-sync), cycle synchronization (C-sync), and inspiratory trigger and cycle synchronization (I/C-sync) for 15 min at each step. Other ventilator settings were kept constant. P_aw, P_es, airflow, P_0.1, respiratory rate, SpO₂, and hemodynamic variables were recorded. The primary outcome was inspiratory trigger and cycle delay time between each intervention. Secondary outcomes were delta P_aw and P_es drop during the trigger phase, P_0.1, SpO₂, and hemodynamic variables.

Results:

The time to initiate the trigger was significantly shorter with I-sync compared to baseline (208.9±91.7 vs. 301.4±131.7 msec; P = 0.002) and I/C-sync compared to baseline (222.8±94.0 vs. 301.4±131.7 msec; P = 0.005). The I/C-sync group had significantly lower delta P_aw and P_es drop during the trigger phase compared to C-sync group (-0.7±0.4 vs. -1.2±0.8 cmH₂O; P = 0.028 and - 1.8±2.2 vs. -2.8±3.2 cmH₂O; P = 0.011, respectively). No statistically significant differences were found in cycle delay time, P_0.1 and other physiological variables between the groups.

Conclusions:

IntelliSync + software reduced inspiratory trigger delay time compared to the conventional flow trigger system during PSV mode. However, no significant improvements in cycle delay time and other physiological variables were observed with IntelliSync + software.

Trial Registration:

This study was registered in the Thai Clinical Trial Registry (TCTR20200528003; date of registration 28/05/2020).

Keywords:

Asynchrony Esophageal pressure Patient-ventilator interaction Pressure support ventilation

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