Minimizing Asynchronies in Mechanical Ventilation: Current and Future Trends

Respiratory Care
Carles SubiràL Blanch

Abstract

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.

Citations

Aug 17, 2018·Critical Care Medicine·Federico Gordo-Vidal, Beatriz Lobo-Valbuena
Nov 19, 2019·Current Opinion in Critical Care·Katerina Vaporidi
Jul 7, 2019·Critical Care : the Official Journal of the Critical Care Forum·Candelaria de HaroUNKNOWN Asynchronies in the Intensive Care Unit (ASYNICU) Group
Dec 6, 2018·Scientific Reports·Yaroslav MarchukLluis Blanch
Jul 28, 2019·Intensive Care Medicine Experimental·Candelaria de HaroUNKNOWN Asynchronies in the Intensive Care Unit (ASYNICU) Group
Sep 29, 2020·Frontiers in Pediatrics·Martino PavoneRenato Cutrera
Feb 17, 2021·Anesthesiology·James M Bailey
Feb 27, 2021·Australian Critical Care : Official Journal of the Confederation of Australian Critical Care Nurses·Kay Choong SeeJuvel Taculod
May 5, 2020·Heart & Lung : the Journal of Critical Care·Jaber S AlqahtaniYaseen M Arabi
Apr 3, 2021·Intensive Care Medicine·John J MariniLuciano Gattinoni
May 29, 2021·World Journal of Critical Care Medicine·Jaber S Alqahtani
Aug 4, 2021·British Journal of Anaesthesia·Guillermo M AlbaicetaLluis Blanch

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