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Outcomes of ventilatory asynchrony in patients with inspiratory effort
OBJECTIVE: To identify the relationship of patient-ventilator asynchrony with the level of sedation and hemogasometric and clinical results. METHODS: This was a prospective study of 122 patients admitted to the intensive care unit who underwent > 24 hours of invasive mechanical ventilation with i...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Associação de Medicina Intensiva Brasileira - AMIB
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7405741/ https://www.ncbi.nlm.nih.gov/pubmed/32667451 http://dx.doi.org/10.5935/0103-507X.20200045 |
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author | Martos-Benítez, Frank Daniel Domínguez-Valdés, Yairén Burgos-Aragüez, Dailé Larrondo-Muguercia, Hilev Orama-Requejo, Versis Lara-Ponce, Karla Ximena González-Martínez, Iraida |
author_facet | Martos-Benítez, Frank Daniel Domínguez-Valdés, Yairén Burgos-Aragüez, Dailé Larrondo-Muguercia, Hilev Orama-Requejo, Versis Lara-Ponce, Karla Ximena González-Martínez, Iraida |
author_sort | Martos-Benítez, Frank Daniel |
collection | PubMed |
description | OBJECTIVE: To identify the relationship of patient-ventilator asynchrony with the level of sedation and hemogasometric and clinical results. METHODS: This was a prospective study of 122 patients admitted to the intensive care unit who underwent > 24 hours of invasive mechanical ventilation with inspiratory effort. In the first 7 days of ventilation, patient-ventilator asynchrony was evaluated daily for 30 minutes. Severe patient-ventilator asynchrony was defined as an asynchrony index > 10%. RESULTS: A total of 339,652 respiratory cycles were evaluated in 504 observations. The mean asynchrony index was 37.8% (standard deviation 14.1 - 61.5%). The prevalence of severe patient-ventilator asynchrony was 46.6%. The most frequent patient-ventilator asynchronies were ineffective trigger (13.3%), autotrigger (15.3%), insufficient flow (13.5%), and delayed cycling (13.7%). Severe patient-ventilator asynchrony was related to the level of sedation (ineffective trigger: p = 0.020; insufficient flow: p = 0.016; premature cycling: p = 0.023) and the use of midazolam (p = 0.020). Severe patient-ventilator asynchrony was also associated with hemogasometric changes. The persistence of severe patient-ventilator asynchrony was an independent risk factor for failure of the spontaneous breathing test, ventilation time, ventilator-associated pneumonia, organ dysfunction, mortality in the intensive care unit, and length of stay in the intensive care unit. CONCLUSION: Patient-ventilator asynchrony is a frequent disorder in critically ill patients with inspiratory effort. The patient’s interaction with the ventilator should be optimized to improve hemogasometric parameters and clinical results. Further studies are required to confirm these results. |
format | Online Article Text |
id | pubmed-7405741 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Associação de Medicina Intensiva Brasileira - AMIB |
record_format | MEDLINE/PubMed |
spelling | pubmed-74057412020-08-07 Outcomes of ventilatory asynchrony in patients with inspiratory effort Martos-Benítez, Frank Daniel Domínguez-Valdés, Yairén Burgos-Aragüez, Dailé Larrondo-Muguercia, Hilev Orama-Requejo, Versis Lara-Ponce, Karla Ximena González-Martínez, Iraida Rev Bras Ter Intensiva Original Article OBJECTIVE: To identify the relationship of patient-ventilator asynchrony with the level of sedation and hemogasometric and clinical results. METHODS: This was a prospective study of 122 patients admitted to the intensive care unit who underwent > 24 hours of invasive mechanical ventilation with inspiratory effort. In the first 7 days of ventilation, patient-ventilator asynchrony was evaluated daily for 30 minutes. Severe patient-ventilator asynchrony was defined as an asynchrony index > 10%. RESULTS: A total of 339,652 respiratory cycles were evaluated in 504 observations. The mean asynchrony index was 37.8% (standard deviation 14.1 - 61.5%). The prevalence of severe patient-ventilator asynchrony was 46.6%. The most frequent patient-ventilator asynchronies were ineffective trigger (13.3%), autotrigger (15.3%), insufficient flow (13.5%), and delayed cycling (13.7%). Severe patient-ventilator asynchrony was related to the level of sedation (ineffective trigger: p = 0.020; insufficient flow: p = 0.016; premature cycling: p = 0.023) and the use of midazolam (p = 0.020). Severe patient-ventilator asynchrony was also associated with hemogasometric changes. The persistence of severe patient-ventilator asynchrony was an independent risk factor for failure of the spontaneous breathing test, ventilation time, ventilator-associated pneumonia, organ dysfunction, mortality in the intensive care unit, and length of stay in the intensive care unit. CONCLUSION: Patient-ventilator asynchrony is a frequent disorder in critically ill patients with inspiratory effort. The patient’s interaction with the ventilator should be optimized to improve hemogasometric parameters and clinical results. Further studies are required to confirm these results. Associação de Medicina Intensiva Brasileira - AMIB 2020 /pmc/articles/PMC7405741/ /pubmed/32667451 http://dx.doi.org/10.5935/0103-507X.20200045 Text en http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Martos-Benítez, Frank Daniel Domínguez-Valdés, Yairén Burgos-Aragüez, Dailé Larrondo-Muguercia, Hilev Orama-Requejo, Versis Lara-Ponce, Karla Ximena González-Martínez, Iraida Outcomes of ventilatory asynchrony in patients with inspiratory effort |
title | Outcomes of ventilatory asynchrony in patients with inspiratory effort |
title_full | Outcomes of ventilatory asynchrony in patients with inspiratory effort |
title_fullStr | Outcomes of ventilatory asynchrony in patients with inspiratory effort |
title_full_unstemmed | Outcomes of ventilatory asynchrony in patients with inspiratory effort |
title_short | Outcomes of ventilatory asynchrony in patients with inspiratory effort |
title_sort | outcomes of ventilatory asynchrony in patients with inspiratory effort |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7405741/ https://www.ncbi.nlm.nih.gov/pubmed/32667451 http://dx.doi.org/10.5935/0103-507X.20200045 |
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