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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
PubMed
Summary
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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:

Related Experiment Videos

  • 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.