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Patient-ventilator trigger asynchrony in prolonged mechanical ventilation
D C Chao1, D J Scheinhorn, M Stearn-Hassenpflug
1Barlow Respiratory Hospital and Barlow Respiratory Research Center, Los Angeles, CA 90026, USA.
Chest
|December 24, 1997
Summary
Patient-ventilator trigger asynchrony (TA) in patients on prolonged mechanical ventilation (PMV) is easily identified and linked to poor outcomes. Interventions to correct TA were often unsuccessful or poorly tolerated, highlighting a significant clinical challenge.
Area of Science:
- Critical Care Medicine
- Respiratory Physiology
- Mechanical Ventilation
Background:
- Prolonged mechanical ventilation (PMV) is often complicated by patient-ventilator interactions.
- Patient-ventilator trigger asynchrony (TA) represents a significant challenge in managing patients on mechanical ventilation.
- Understanding the prevalence, causes, and consequences of TA is crucial for improving patient outcomes.
Purpose of the Study:
- To investigate the prevalence, physiologic basis, and clinical implications of patient-ventilator trigger asynchrony (TA).
- To assess the effectiveness of various interventions in resolving TA in patients requiring PMV.
- To evaluate the association between TA and weaning success in a cohort of ventilator-dependent patients.
Main Methods:
- A descriptive, prospective cohort study was conducted at a regional weaning center.
- Two hundred consecutive ventilator-dependent patients undergoing attempted weaning from PMV were assessed for TA.
- Clinical assessment of TA, including esophageal pressure monitoring in a subset, was performed; interventions included PEEP, flow triggering, and pressure support adjustments.
Main Results:
- Nineteen of 200 patients (9.5%) exhibited TA, characterized by older age, higher COPD prevalence, and severe hypercapnia.
- Weaning success was significantly lower in patients with TA (16%) compared to those without TA (57%).
- Interventions like PEEP and flow triggering were largely ineffective; pressure support reduction eliminated TA but caused significant patient distress.
Conclusions:
- Patient-ventilator trigger asynchrony (TA) is clinically identifiable in stable patients on PMV and is associated with poor weaning outcomes.
- Current methods to correct TA are often insufficient or poorly tolerated, indicating a need for improved strategies.
- TA represents a critical factor contributing to prolonged mechanical ventilation and failed weaning attempts.