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As mechanical ventilators have evolved, adding technology and software to allow for more sophisticated breath architecture and pattern of delivery, so too has the advancement of monitoring capabilities, both on and off the ventilator. With these changes comes a mandate for experts in appropriately using modes and settings to best manage the patient according to the therapeutic intention or goal of mechanical ventilation. Aggregating and analyzing data to include waveform graphics are important aspects in the fluency of mechanical ventilation.1 The foundational understanding of normal waveform construction and appearance is a starting point, succeeded by the understanding of abnormal waveform appearance due to the patient-ventilator interaction. Although studies have shown challenges in bedside clinicians' interpretative abilities of waveforms, the research into recognition, etiology, clinical implications, and impact on patient outcomes associated with abnormal patient-ventilator interaction continues to emerge.2–4 In this month's issue of Respiratory Care, Luo and colleagues present a secondary analysis of an observational cohort of subjects with differing etiologies of brain injury, which adds to our understanding of how specific disease processes impact respiratory drive, respiratory pattern, and the interaction with the mechanical ventilator.5
Early work with regard to patient-ventilator interaction recognized the appearance of abnormalities and documented incidence, while attempting to classify an expanding catalog of interpretations. Narrative reviews grouped the abnormalities according to occurrence in the respiratory cycle or the mechanistic etiology.6,7 Relative to the work in this month's Respiratory Care, the abnormalities that occur at the initiation of the breath are fundamentally due to a lack of synchrony or timing; specifically, there is discordance between the timing of the patient's initiation of the breath and the ventilator's initiation of the breath. This timing discrepancy, which falls under the larger umbrella of …
Correspondence: Eric Kriner RRT FAARC, MedStar Washington Hospital Center, Respiratory Therapy, 110 Irving St, NW, Washington, DC 20010. E-mail: eric.j.kriner{at}medstar.net
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