Indian Journal of Respiratory Care

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VOLUME 4 , ISSUE 2 ( July-December, 2015 ) > List of Articles

REVIEW ARTICLE

Patient-Ventilator Asynchrony: The Power Struggle

Madhuragauri Shevade, Komalkirti Apte

Keywords : Asynchrony, Neurally Adjusted Ventilatory Assist, Patient-ventilator, Proportional Assist Ventilation

Citation Information : Shevade M, Apte K. Patient-Ventilator Asynchrony: The Power Struggle. Indian J Respir Care 2015; 4 (2):594-598.

DOI: 10.5005/jp-journals-11010-04202

License: NA

Published Online: 02-12-2022

Copyright Statement:  NA


Abstract

Patient ventilator asynchrony (PVA) is a prevalent phenomenon seen in almost 25% of our intensive care unit patients. PVA can be trigger asynchrony, flow asynchrony, cycle asynchrony or mode asynchrony. Ineffective triggering is the most commonly occurring asynchrony. The best way to identify PVA is via the ventilator graphics. Corrective steps and manipulating the ventilator on the conventional mode to suit the patient's needs can help reduce the incidence of PVA. Recent advances have given rise to newer modes of ventilation such as Neurally Adjusted Ventilatory Assist and Proportional Assist Ventilation with the goal of reducing the frequency of PVA. Many new methods to reduce asynchronies are being studied; however additional large scale trials are needed to come to conclusive results. This article is an attempt to simplify the various asynchronies for better application to all healthcare professionals.


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  1. Kacmarek R. The Mechanical Ventilator: past, present, and future. Respiratory Care 2011;56:1170-80
  2. Branson R, Patient-Ventilator Interaction: The last 40 years. Respiratory Care 2011; 56:15-22
  3. Epstein S. How often does patient-ventilator asynchrony occur and what are the consequences? Respiratory Care 2011;56:25-35
  4. Gutierrez G, Ballarino GJ, Turkan H, Abril J, Cruz LDL, Edsall C, et al. Automatic detection of patient-ventilator asynchrony by spectral analysis of airway flow. Critical Care 2011:15:R167
  5. MacIntyre N. Patient-ventilator interactions: optimizing conventional ventilation modes. Respiratory Care 2011;56:73-81
  6. Branson R, Blakeman T, Robinson B. Asynchrony and dyspnea. Respiratory Care 2013;58:973-86
  7. Wit MD, 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. Sassoon C. Triggering of the ventilator in patient-ventilator interactions. Respiratory Care 2011;56:39-48
  9. Liao K, Ou C, Chen C. Classifying different types of double triggering based on airway pressure and flow deflection in mechanically ventilated patients. Respiratory Care 2011;56:460-6
  10. 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;143:927-38
  11. Schmidt M, Kindler F, Cecchini J, Poitou T, Morawiec E, Persichini R, et al. Neurally adjusted ventilatory assist and proportional assist ventilation both improve patientventilator interaction. Critical Care 2015;19:56
  12. Mellott KG, Grap MJ, Munro CL, Sessler CN, Wetzel PA, Nilsestuen JO, et al. Patient ventilator asynchrony in critically ill adults: frequency and types. Heart Lung 2014;43:231-43.
  13. Carteaux G, Lyazidi A, Cordoba-Izquierdo A, Vignaux L, Jolliet P, Thille AW, et al. Patient- ventilator asynchrony during noninvasive ventilation. Chest 2012;142:367-76
  14. Carlucci A, Pisani P, Ceriana P, Malovini A, Nava S. Patient-ventilator asynchronies: may the respiratory mechanics play a role? Critical Care 2013;17:R54
  15. Nilsestuen J, Hargett K. Using ventilator graphics to identify patient-ventilator asynchrony. Respiratory Care 2005;50:202-32
  16. Sinderby C, Liu S, Colombo D, Camarotta G, Slutsky AS, Navalesi P, et al. An automated and standardized neural index to quantify patient-ventilator interaction. Critical Care 2013;17:R239
  17. Piquilloud L, Jolliet P, Revelly J. Automated detection of patient-ventilator asynchrony: new tool or new toy? Critical Care 2013;17:1015
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