RT Journal Article
SR Electronic
T1 Minimizing Asynchronies in Mechanical Ventilation: Current and Future Trends
JF Respiratory Care
FD American Association for Respiratory Care
SP 464
OP 478
DO 10.4187/respcare.05949
VO 63
IS 4
A1 Subirà, Carles
A1 de Haro, Candelaria
A1 Magrans, Rudys
A1 Fernández, Rafael
A1 Blanch, Lluís
YR 2018
UL http://rc.rcjournal.com/content/63/4/464.abstract
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.