TY - JOUR T1 - PATIENT-VENTILATOR ASYNCHRONY IN A TRAUMATICALLY INJURED POPULATION JF - Respiratory Care DO - 10.4187/respcare.02237 SP - respcare.02237 AU - Bryce RH Robinson AU - Thomas Blakeman AU - Peter Toth AU - Dennis J Hanseman AU - Eric Mueller AU - Richard Branson Y1 - 2013/03/19 UR - http://rc.rcjournal.com/content/early/2013/03/19/respcare.02237.abstract N2 - Introduction: Prolonged mechanical ventilation, increased length of hospital stay, and a lower rate of home discharge have been reported with patient-ventilator asynchrony in medical patients. Though commonly encountered, asynchrony is poorly defined within a traumatically injured population. Methods: Mechanically ventilated trauma patients at an urban, level I center were enrolled. Breath waveforms were recorded over 30 minutes within the first 48 hours following intubation. Asynchronous breaths were defined as ineffective patient triggering, double triggering, short cycle breaths, and long cycle breaths. Asynchronous patients were defined as having asynchrony in ≥10% of total breaths. Demographic, injury, sedation/delirium scores, clinical and discharge outcomes were prospectively collected. Results: 35 patients were enrolled. Median age was 47 years, 77.1% male, 28.6% with penetrating injuries, 16% with a history of COPD, median ISS of 22 (IQR 17–27), and a median chest AIS of 2 (IQR 0–6). 15,445 breaths were analyzed. Asynchrony was present in 25.7% of patients. No statistical differences between asynchronous and non-asynchronous patients were found for age, sex, injury mechanism, COPD history, delirium/sedation scores, PaO2/FiO2 ratios, PEEP, blood gas values, sedative, narcotic and haloperidol use. Asynchronous patients more commonly used synchronized intermittent mandatory ventilation (SIMV) (100% vs. 38.5%; p=0.002) and took lower median spontaneous breaths per minute (4 (IQR 3–8) vs. 12 (IQR 9–14); p=0.007). SIMV with set respiratory rates ≥10 breaths per minute were associated with increased asynchrony rates (85.7% vs. 25.0%, p=0.02). We found no difference in ventilator days, ICU and hospital lengths of stay, % discharged home, or mortality between asynchronous and non-asynchronous patients. Conclusions: Ventilator asynchrony is common in trauma patients. It may be associated with SIMV with a set respiratory rate ≥10 breaths per minute, though not with increased duration of mechanical ventilation, length of stay, or discharge disposition. ER -