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2020, Number 5

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Med Crit 2020; 34 (5)

Prognosis impact of the asynchronies in the mechanical ventilated patient

Nicolás MEL, Mercado VP, Vidal MJJ, Rivero SE, Domínguez CG

Language: Spanish
References: 30
Page: 273-278
PDF size: 211.02 Kb.


ABSTRACT

Mechanical ventilation is common in critically ill patients. Patient-ventilator asynchrony exists when the breathing phases administered by the ventilator do not match those of the patient. They are frequent but underdiagnosed, and have been associated with worse outcomes because they negatively affect patient comfort, length of mechanical ventilation, length of stay in the intensive care unit and mortality. This review describes the negative outcomes associated with the presence of asynchronies in adult patients with invasive mechanical ventilation. Current evidence suggests that the best approach to handle asynchronies is to adjust the fan settings and improve the quality of detection. While most of this evidence comes from observational studies and randomized clinical trials which were done with heterogeneous populations and a limited number of patients, the results suggest less favorable clinically significant outcomes in patients with asynchronies. So it is necessary to generate more evidence in this topic.


REFERENCES

  1. Mehta AB, Syeda SN, Wiener RS, Walkey AJ. Epidemiological trends in invasive mechanical ventilation in the United States: a population-based study. J Crit Care. 2015;30:1217-1221.

  2. Jackson JC, Mitchell N, Hopkins RO. Cognitive functioning, mental health, and quality of life in ICU survivors: an overview. Psychiatr Clin North Am. 2015;38:91-104.

  3. Thille AW, Rodriguez P, Cabello B, Lellouche F, Brochard L. Patient-ventilator asynchrony during assisted mechanical ventilation. Intensive Care Med. 2006;32:1515-1522.

  4. Bruni A, Garofalo E, Pelaia C, Messina A, Cammarota G, Murabito P, et al. Patient-ventilator asynchrony in adult critically ill patients. Minerva Anestesiol. 2019;85:676-688.

  5. Blanch L, Villagra A, Sales B, Montanya J, Lucangelo U, Luján M, et al. Asynchronies during mechanical ventilation are associated with mortality. Intensive Care Med. 2015;41:633-634.

  6. Pham T, Telias I, Piraino T, Yoshida T, Brochard LJ. Asynchrony consequences and management. Crit Care Clin. 2018;34:325-341.

  7. De Wit M, Pedram S, Best AM, Epstein SK. Observational study of patient-ventilator asynchrony and relationship to sedation level. J Crit Care. 2009;24:74-80.

  8. de Wit M, Miller KB, Green DA, Ostman HE, Gennings C, Epstein SK. Ineffective triggering predicts increased duration of mechanical ventilation. Crit Care Med. 2009;37:2740-2745.

  9. Bosma K, Ferreyra G, Ambrogio C, Pasero D, Mirabella L, Braghiroli A, et al. Patient- ventilator interaction and sleep in mechanically ventilated patients: pressure support versus proportional assist ventilation. Crit Care Med. 2007;35:1048-1054.

  10. Vaschetto R, Cammarota G, Colombo D, Longhini F, Grossi F, Giovanniello A, et al. Effects of propofol on patient-ventilator synchrony and interaction during pressure support ventilation and neurally adjusted ventilatory assist. Crit Care Med. 2014;42:74-82.

  11. Schmidt M, Banzett RB, Raux M, Morélot-Panzini C, Dangers L, Similowski T, et al. Unrecognized suffering in the ICU: & addressing dyspnea in mechanically ventilated patients. Intensive Care Med. 2014;40:1-10.

  12. Akoumianaki E, Lyazidi A, Rey N, Matamis D, Perez-Martinez N, Giraud R, et al. Mechanical ventilation-induced reverse- triggered breaths: a frequently unrecognized form of neuromechanical coupling. Chest. 2013;143:927-938.

  13. Conti G, Ranieri VM, Costa R, Garratt C, Wighton A, Spinazzola G, et al. Effects of dexmedetomidine and propofol on patient-ventilator interaction in diffi cult-to-wean, mechanically ventilated patients: a prospective, open-label, randomised, multicentre study. Crit Care. 2016;20(1):206.

  14. Watson PL, Shintani AK, Tyson R, Pandharipande PP, Pun BT, Wesley EE. Presence of electroencephalogram burst suppression in sedated, critically ill patients is associated with increased mortality. Crit Care Med. 2008;36(12):3171-3177.

  15. Kollef MH, Levy NT, Ahrens TS, Schaiff R, Prentice D, Sherman G. The use of continuous i.v. sedation is associated with prolongation of mechanical ventilation. Chest. 1998;114(2):541-554.

  16. Papazian L, Forel JM, Gacouin A, Penot-Ragon C, Perrin G, Loun- dou A, et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010;363(12):1107-1116.

  17. Hermans G, Agten A, Testelmans D, Decramer M, Gayan-Ramirez G. Increased duration of mechanical ventilation is associated with decreased diaphragmatic force: a prospective observational study. Crit Care. 2010;14(4):R127.

  18. Jaber S, Petrof BJ, Jung B, Chanques G, Berthet JP, Rabuel C, et al. Rapidly progressive diaphragmatic weakness and injury during mechanical ventilation in humans. Am J Respir Crit Care Med. 2011;183(3):364-371.

  19. Schmidt M, Demoule A, Polito A, Porchet R, Aboab J, Siami S, et al. Dyspnea in mechanically ventilated critically ill patients. Crit Care Med. 2011;39:2059-2065.

  20. Jubran A, Lawm G, Kelly J, Duffner LA, Gungor G, Collins EG, et al. Depressive disorders during weaning from prolonged mechanical ventilation. Intensive Care Med. 2010;36:828-835.

  21. Drouot X, Cabello B, d’Ortho MP, Brochard L. Sleep in the Intensive Care Unit. Sleep Med Rev. 2008;12:391-403.

  22. Alexopoulou C, Kondili E, Vakouti E, Klimathianaki M, Prinianakis G, Georgopoulos D. Sleep during proportional-assist ventilation with load adjustable gain factors in critically ill patients. Intensive Care Med. 2007;33(7):1139-1147.

  23. Delisle S, Ouellet P, Bellemare P, Tétrault JP, Arsenault P. Sleep quality in mechanically ventilated patients: comparison between NAVA and PSV modes. Ann Intensive Care. 2011;28;1(1):42.

  24. Alexopoulou C, Kondili E, Plataki M, Georgopoulos D. Patient-ventilator synchrony and sleep quality with proportional assist and pressure support ventilation. Intensive Care Med. 2013;39:1040-1047.

  25. Chao DC, Scheinhorn DJ, Stearn-Hssenpflug M. Patient-ventilator trigger asynchrony in prolonged mechanical ventilation. Chest. 1997;112:1592-1599.

  26. Pohlman MC, McCallister KE, Schweickert WD, Pohlman AS, Nigos CP, Krishnan JA, et al. Excessive tidal volume from breath stacking during lung protective ventilation for acute lung injury. Crit Care Med. 2008;36:3019-3023.

  27. Robinson BR, Blakeman TC, Toth P, Hanseman DJ, Mueller E, Branson RD. Patient-ventilator asyn¬chrony in a traumatically injured population. Respir Care. 2013;58:1847-1855.

  28. Beitler JR, Sands SA, Loring SH, Owens RL, Malhotra A, Spragg RG, et al. Quantifying unintended exposure to high tidal volumes from breath stacking dyssynchrony in ARDS: the BREATHE criteria. Intensive Care Med. 2016;42:1427-1436.

  29. Vaporidi K, Babalis D, Chytas A, Lilitsis E, Kondili E, Amargianitakis V, et al. Clusters of ineffective efforts during mechanical ventilation: impact on outcome. Intensive Care Med. 2017;43(2):184-191.

  30. Rolland-Debord C, Bureau C, Poitou T, Belin L, Clavel M, Perbet S, et al. Prevalence and prognosis impact of patient-ventilator asynchrony in early phase of weaning according to two detection methods. Anesthesiology. 2017;127:989-997.




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