Asynchronies during mechanical ventilation are associated with mortality

Lluís Blanch, Ana Villagra, Bernat Sales, Jaume Montanya, Umberto Lucangelo, Manel Luján, Oscar García-Esquirol, Encarna Chacón, Anna Estruga, Joan C. Oliva, Alberto Hernández-Abadia, Guillermo M. Albaiceta, Enrique Fernández-Mondejar, Rafael Fernández, Josefina Lopez-Aguilar, Jesús Villar, Gastón Murias, Robert M. Kacmarek

    Research output: Contribution to journalArticleResearchpeer-review

    182 Citations (Scopus)

    Abstract

    © 2015, Springer-Verlag Berlin Heidelberg and ESICM. Purpose: This study aimed to assess the prevalence and time course of asynchronies during mechanical ventilation (MV). Methods: Prospective, noninterventional observational study of 50 patients admitted to intensive care unit (ICU) beds equipped with Better Care™ software throughout MV. The software distinguished ventilatory modes and detected ineffective inspiratory efforts during expiration (IEE), double-triggering, aborted inspirations, and short and prolonged cycling to compute the asynchrony index (AI) for each hour. We analyzed 7,027 h of MV comprising 8,731,981 breaths. Results: Asynchronies were detected in all patients and in all ventilator modes. The median AI was 3.41 % [IQR 1.95–5.77]; the most common asynchrony overall and in each mode was IEE [2.38 % (IQR 1.36–3.61)]. Asynchronies were less frequent from 12 pm to 6 am [1.69 % (IQR 0.47–4.78)]. In the hours where more than 90 % of breaths were machine-triggered, the median AI decreased, but asynchronies were still present. When we compared patients with AI > 10 vs AI ≤ 10 %, we found similar reintubation and tracheostomy rates but higher ICU and hospital mortality and a trend toward longer duration of MV in patients with an AI above the cutoff. Conclusions: Asynchronies are common throughout MV, occurring in all MV modes, and more frequently during the daytime. Further studies should determine whether asynchronies are a marker for or a cause of mortality.
    Original languageEnglish
    Pages (from-to)633-641
    JournalIntensive Care Medicine
    Volume41
    Issue number4
    DOIs
    Publication statusPublished - 1 Apr 2015

    Keywords

    • Mechanical ventilation
    • Mortality
    • Patient–ventilator asynchrony
    • Respiratory monitoring

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