Patient-ventilator Dyssynchrony: Detection, Importance, and Management

Patient-ventilator dyssynchrony (PVD) is frequent during assisted mechanical ventilation and reflects a mismatch between the patient's respiratory demands and ventilatory assistance. PVD can be classified according to their predominant mechanisms into high respiratory drive/underassistance, low respiratory drive/overassistance, and reverse triggering, the last emerging during the transition to lighter sedation. Their clinical impact is influenced by their physiologic consequences, particularly the effort magnitude and the presence of breath stacking. Although PVD has been associated with worse outcomes, emerging evidence indicates that some specific types are not always harmful. Management should be individualized according to the underlying mechanism and clinical context.