Patient-ventilator asynchrony during critical care transport: evidence and framework

Transport of invasively ventilated patients is a necessary but vulnerable phase of critical care, yet patient-ventilator asynchrony (PVA) has rarely been measured directly during transport. This structured narrative review integrates transport studies, ventilator bench evaluations, ICU physiology, and monitoring research, with a targeted PubMed update on 1 October 2026. Transport-associated waveform reports, clinical labels, and treatment records provide different levels of diagnostic certainty. We identified no prospective cohort continuously comparing PVA before, during, and after transport using synchronized ventilator and patient-effort signals; incomplete historical search documentation limits this absence statement. Transport-specific incidence and clinical consequences remain uncertain. Bench performance is device- and condition-dependent, and ICU studies show heterogeneous outcome associations and intervention effects. We therefore propose an unvalidated framework spanning patient vulnerability, circuit integrity, transport ventilator performance, and environmental and operational disturbance. These domains may influence triggering, flow delivery, cycling, and respiratory rhythm through overlapping mechanisms. A proposed safety-first workflow prioritizes effective oxygenation and ventilation, airway-circuit-device assessment, and contextual interpretation of suspected phenotypes. Motion artifact, true triggering disturbances, and indeterminate patterns must be distinguished; advanced effort measurements primarily support research validation. Initial studies should establish synchronized-signal completeness, interpretable recording time, artifact burden, and inter-rater agreement before testing clinical benefit and balancing harms.