Related Experiment Video
Updated: May 16, 2025
Monitoring Lung Function with Electrical Impedance Tomography in the Intensive Care Unit
Published on: September 6, 2024
An overview of patient-ventilator asynchrony in children
Benjamin Yoon1, Robert Blokpoel2, Chatila Ibn Hadj Hassine3
1Section of Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
Insights
Patient-ventilator asynchrony (PVA) is common in mechanically ventilated children. Further research is needed to understand its clinical impact and develop targeted interventions for this understudied population.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Physiology
- Mechanical Ventilation
Background:
- Patient-ventilator asynchrony (PVA) is a frequent complication in mechanically ventilated children.
- PVA signifies a mismatch between a patient's spontaneous respiratory effort and the ventilator's delivered breaths.
- Pediatric patients possess unique physiological characteristics that influence PVA occurrence and presentation.
Purpose of the Study:
- To review subtypes of PVA in pediatric patients.
- To discuss methods for detecting and measuring PVA.
- To explore risk factors, clinical implications, and management strategies for PVA in children.
Main Methods:
- Literature review focusing on PVA in pediatric mechanical ventilation.
- Synthesis of current knowledge on PVA detection, characteristics, and implications.
- Identification of research gaps and future directions.
Main Results:
- PVA is common but understudied in pediatric populations.
- Pediatric-specific factors contribute to PVA.
- Clinical implications and optimal treatments for PVA remain largely unknown.
Conclusions:
- Harmonizing PVA terminology and refining detection technologies are crucial.
- Further research is necessary to identify harmful PVA types and develop effective interventions.
- Understanding and managing PVA is vital for improving outcomes in mechanically ventilated children.
Introduction:
Mechanically ventilated children often have patient-ventilator asynchrony (PVA). When a ventilated patient has spontaneous effort, the ventilator attempts to synchronize with the patient, but PVA represents a mismatch between patient respiratory effort and ventilator delivered breaths.
Areas Covered:
This review will focus on subtypes of patient ventilator asynchrony, methods to detect or measure PVA, risk factors for and characteristics of patients with PVA subtypes, potential clinical implications, treatment or prevention strategies, and future areas for research. Throughout this review, we will provide pediatric specific considerations.
Expert Opinion:
PVA in pediatric patients supported by mechanical ventilation occurs frequently and is understudied. Pediatric patients have unique physiologic and pathophysiologic characteristics which affect PVA. While recognition of PVA and its subtypes is important for bedside clinicians, the clinical implications and risks versus benefits of treatment targeted at reducing PVA remain unknown. Future research should focus on harmonizing PVA terminology, refinement of automated detection technologies, determining which forms of PVA are harmful, and development of PVA-specific ventilator interventions.
Related Concept Videos
01:14Ventilatory Modes
There are three ventilatory modes: full support, partial support, and spontaneous. These are described below.
Full Support Modes
Full support modes include controlled mechanical ventilation, continuous mandatory...
01:23Mechanical Ventilation II: Invasive Ventilation
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
01:29Mechanical Ventilation I: Indication and Settings
01:20Assessment of Ventilation I: Respiratory Rate
A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation:
01:29Assessment of Ventilation II: Respiratory Depth and Rhythm
Respiratory depth measures the volume of air inhaled or exhaled during a breath. It can vary from shallow to deep and typically remains consistent when a person is at rest or asleep. Occasionally, individuals will automatically inhale deeply, known as sighing, which inflates the lungs with more air than normal breathing.
To assess respiratory depth, observe the degree of chest excursion or movement:
01:23Mechanical Ventilation III: Noninvasive Ventilation
Noninvasive Positive-Pressure Ventilation...