PT  - JOURNAL ARTICLE
AU  - Subirà, Carles
AU  - de Haro, Candelaria
AU  - Magrans, Rudys
AU  - Fernández, Rafael
AU  - Blanch, Lluís
TI  - Minimizing Asynchronies in Mechanical Ventilation: Current and Future Trends
AID  - 10.4187/respcare.05949
DP  - 2018 Apr 01
TA  - Respiratory Care
PG  - 464--478
VI  - 63
IP  - 4
4099  - http://rc.rcjournal.com/content/63/4/464.short
4100  - http://rc.rcjournal.com/content/63/4/464.full
AB  - Patient-ventilator asynchrony exists when the phases of breath delivered by the ventilator do not match those of the patient. Asynchronies occur throughout mechanical ventilation and negatively affect patient comfort, duration of mechanical ventilation, length of ICU stays, and mortality. Identifying asynchronies requires careful attention to patients and their ventilator waveforms. This review discusses the different types of asynchronies, how they are generated, and their impact on patient comfort and outcome. Moreover, it discusses practical approaches for detecting, correcting, and preventing asynchronies. Current evidence suggests that the best approach to managing asynchronies is by adjusting ventilator settings. Proportional modes improve patient-ventilator coupling, resulting in greater comfort and less dyspnea, but not in improved outcomes with respect to the duration of mechanical ventilation, delirium, or cognitive impairment. Advanced computational technologies will allow smart alerts, and models based on time series of asynchronies will be able to predict and prevent asynchronies, making it possible to tailor mechanical ventilation to meet each patient's needs throughout the course of mechanical ventilation.