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- Title
Asynchronies during mechanical ventilation are associated with mortality.
- Authors
Blanch, Lluís; Villagra, Ana; Sales, Bernat; Montanya, Jaume; Lucangelo, Umberto; Luján, Manel; García-Esquirol, Oscar; Chacón, Encarna; Estruga, Anna; Oliva, Joan; Hernández-Abadia, Alberto; Albaiceta, Guillermo; Fernández-Mondejar, Enrique; Fernández, Rafael; Lopez-Aguilar, Josefina; Villar, Jesús; Murias, Gastón; Kacmarek, Robert
- Abstract
Purpose: This study aimed to assess the prevalence and time course of asynchronies during mechanical ventilation (MV). Methods: Prospective, noninterventional observational study of 50 patients admitted to intensive care unit (ICU) beds equipped with Better Care™ software throughout MV. The software distinguished ventilatory modes and detected ineffective inspiratory efforts during expiration (IEE), double-triggering, aborted inspirations, and short and prolonged cycling to compute the asynchrony index (AI) for each hour. We analyzed 7,027 h of MV comprising 8,731,981 breaths. Results: Asynchronies were detected in all patients and in all ventilator modes. The median AI was 3.41 % [IQR 1.95-5.77]; the most common asynchrony overall and in each mode was IEE [2.38 % (IQR 1.36-3.61)]. Asynchronies were less frequent from 12 pm to 6 am [1.69 % (IQR 0.47-4.78)]. In the hours where more than 90 % of breaths were machine-triggered, the median AI decreased, but asynchronies were still present. When we compared patients with AI > 10 vs AI ≤ 10 %, we found similar reintubation and tracheostomy rates but higher ICU and hospital mortality and a trend toward longer duration of MV in patients with an AI above the cutoff. Conclusions: Asynchronies are common throughout MV, occurring in all MV modes, and more frequently during the daytime. Further studies should determine whether asynchronies are a marker for or a cause of mortality.
- Subjects
ARTIFICIAL respiration; RESPIRATORY therapy; MORTALITY; CRITICALLY ill; CRITICAL care medicine
- Publication
Intensive Care Medicine, 2015, Vol 41, Issue 4, p633
- ISSN
0342-4642
- Publication type
Article
- DOI
10.1007/s00134-015-3692-6