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ReplyCorrespondence

Patient-Ventilator Asynchrony and Standard Waveforms: Looks Can Be Deceiving—Reply

Ivan I Ramirez, Daniel H Arellano and Rodrigo S Adasme
Respiratory Care July 2017, 62 (7) 1004-1005; DOI: https://doi.org/10.4187/respcare.05648
Ivan I Ramirez
Division of Critical Care Medicine Hospital Clínico Universidad de Chile Santiago, Chile Universidad de los Andes Santiago, Chile
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Daniel H Arellano
Division of Critical Care Medicine Hospital Clínico Universidad de Chile Santiago, Chile
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Rodrigo S Adasme
Division of Pediatric and Neonatal Critical Care Medicine Hospital Clínico Universidad Católica Santiago, Chile Health Public and Epidemiology Department Universidad de los Andes Santiago, Chile
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In reply:

We sincerely thank Jeffrey Haynes for his comments on our study.1 We agree with Mr Haynes when he points out that there are occasions in which patient-ventilator asynchrony cannot be identified by standard waveform analysis and that other assessment tools, such as diaphragmatic electromyography, are needed to effectively identify its presence. This is a very important point, considering that a significant percentage of asynchronies are underestimated using standard waveform analysis. However, identifying patient-ventilator asynchrony using waveform analysis is an available tool in all modern mechanically ventilators that has been shown to have good correlation with other methods, such as diaphragmatic pressure measurement.2

It is also important to consider that diaphragmatic electromyography has proved to be a very useful tool to obtain very interesting results from the physiological point of view,3 but it is not frequently used during daily clinical practice to identify patient-ventilator asynchrony in mechanically ventilated patients in the ICU. It could be an interesting idea to develop some cost-effectiveness studies in which we could investigate whether reducing patient-ventilator asynchrony through correct interpretation of standard waveform analysis improves clinical outcomes with regard to incremental cost-effectiveness ratios. Finally, it is important to remember that the main objective of our study was not to determine the best method or tool to identify patient-ventilator asynchrony, but to assess the ability of ICU health-care professionals to identify patient-ventilator asynchrony using standard waveform analysis.

Footnotes

  • The authors have disclosed no conflicts of interest.

  • Copyright © 2017 by Daedalus Enterprises

Reference

  1. 1.↵
    1. Ramirez II,
    2. Arellano DH,
    3. Adasme RS,
    4. Landeros JM,
    5. Salinas FA,
    6. Vargas AG,
    7. et al
    . Ability of ICU health-care professionals to identify patient-ventilator asynchrony using waveform analysis. Respir Care 2017;62(2):144–149.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Thille AW,
    2. Rodriguez P,
    3. Cabello B,
    4. Lellouche F,
    5. Brochard L
    . Patient-ventilator asynchrony during assisted mechanical ventilation. Intensive Care Med 2006;32(10):1515–1522.
    OpenUrlCrossRefPubMed
  3. 3.↵
    1. Muttini S,
    2. Villani PG,
    3. Trimarco R,
    4. Bellani G,
    5. Grasselli G,
    6. Patroniti N
    . Relation between peak and integral of the diaphragm electromyographic activity at different levels of support during weaning from mechanical ventilation: a physiologic study. J Crit Care 2015;30(1):7–12.
    OpenUrl
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Respiratory Care: 62 (7)
Respiratory Care
Vol. 62, Issue 7
1 Jul 2017
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Patient-Ventilator Asynchrony and Standard Waveforms: Looks Can Be Deceiving—Reply
Ivan I Ramirez, Daniel H Arellano, Rodrigo S Adasme
Respiratory Care Jul 2017, 62 (7) 1004-1005; DOI: 10.4187/respcare.05648

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Patient-Ventilator Asynchrony and Standard Waveforms: Looks Can Be Deceiving—Reply
Ivan I Ramirez, Daniel H Arellano, Rodrigo S Adasme
Respiratory Care Jul 2017, 62 (7) 1004-1005; DOI: 10.4187/respcare.05648
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