Asynchronies during mechanical ventilation are associated with mortality
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This study aimed to assess the prevalence and time course of asynchronies during mechanical ventilation (MV).
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.
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.
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.
KeywordsPatient–ventilator asynchrony Mechanical ventilation Mortality Respiratory monitoring
The authors thank Mercè Ruiz and Mr. John Giba for their invaluable support in editing the manuscript. This study was financially supported by ISCIII PI09/91074, PI13/02204, CIBER Enfermedades Respiratorias, Fundación Mapfre, Fundació Parc Taulí, Plan Avanza TSI-020302-2008-38, MCYIN and MITYC (Spain). No funding organization or sponsor was involved in the design or conduct of the study, in the collection, management, analysis, or interpretation of the data, or in the preparation, review, or approval of the manuscript..
Conflicts of interest
Blanch, Sales, and Murias are inventors of one Corporació Sanitaria Parc Taulí owned US patent: “Method and system for managed related patient parameters provided by a monitoring device,” US Patent No. 12/538,940. Blanch, Sales, Murias, and Lucangelo own stock options of BetterCare S.L., which is a research and development spinoff of Corporació Sanitària Parc Taulí (Spain). Kacmarek is a consultant for Covidien, has received research grants from Covidien and Hollister, and has received honoraria from Maquet for lectures. Villar has received research grants from Maquet. Montanya, Villagrá, Luján, Garcia-Esquirol, Chacón, Estruga, Oliva, Hernandez Abadia, Albaiceta, Fernandez-Mondejar, López-Aguilar and Fernandez have no conflicts of interest.
- 8.Shehabi Y, Chan L, Kadiman S, Alias A, Ismail WN, Tan MA, Khoo TM, Ali SB, Saman MA, Shaltut A, Tan CC, Yong CY, Bailey M (2013) Sedation depth and long-term mortality in mechanically ventilated critically ill adults: a prospective longitudinal multicentre cohort study. Intensive Care Med 39:910–918CrossRefPubMedCentralPubMedGoogle Scholar
- 13.Tobin MJ, Jubran A, Laghi F (2013) Fighting the ventilator. In: Tobin MJ (ed) Principles and practice of mechanical ventilation. McGraw-Hill, New York, pp 1237–1259 Google Scholar
- 17.Blanch L, Sales B, Montanya J, Lucangelo U, Garcia-Esquirol O, Villagra A, Chacon E, Estruga A, Borelli M, Burgueno MJ, Oliva JC, Fernandez R, Villar J, Kacmarek R, Murias G (2012) Validation of the Better Care® system to detect ineffective efforts during expiration in mechanically ventilated patients: a pilot study. Intensive Care Med 38:772–780CrossRefPubMedGoogle Scholar
- 19.Villagra A, Sales B, Montanya J, Fernandez R, Chacon E, Estruga A, Lucangello U, Garcia-Esquiro O, Albaiceta GM, Hernandez-Abadia A, Mondejar EF, Burgueno MJ, Oliva JC, Villar J, Kacmareck RB, Murias G, Blanch L (2012) Prevalence of patient–ventilator asynchrony in critically ill patients. Intensive Care Med 38:S265–S265Google Scholar
- 20.Villar J, Blanco J, Anon JM, Santos-Bouza A, Blanch L, Ambros A, Gandia F, Carriedo D, Mosteiro F, Basaldua S, Fernandez RL, Kacmarek RM (2011) The ALIEN study: incidence and outcome of acute respiratory distress syndrome in the era of lung protective ventilation. Intensive Care Med 37:1932–1941CrossRefPubMedGoogle Scholar
- 22.Correger E, Murias G, Chacon E, Estruga A, Sales B, Lopez-Aguilar J, Montanya J, Lucangelo U, Garcia-Esquirol O, Villagra A, Villar J, Kacmarek RM, Burgueno MJ, Blanch L (2012) Interpretation of ventilator curves in patients with acute respiratory failure. Med Intensiva 36:294–306CrossRefPubMedGoogle Scholar
- 32.Vaschetto R, Cammarota G, Colombo D, Longhini F, Grossi F, Giovanniello A, Della Corte F, Navalesi P (2014) Effects of propofol on patient–ventilator synchrony and interaction during pressure support ventilation and neurally adjusted ventilatory assist. Crit Care Med 42:74–82CrossRefPubMedGoogle Scholar
- 35.Esteban A, Frutos-Vivar F, Muriel A, Ferguson ND, Penuelas O, Abraira V, Raymondos K, Rios F, Nin N, Apezteguia C, Violi DA, Thille AW, Brochard L, Gonzalez M, Villagomez AJ, Hurtado J, Davies AR, Du B, Maggiore SM, Pelosi P, Soto L, Tomicic V, D’Empaire G, Matamis D, Abroug F, Moreno RP, Soares MA, Arabi Y, Sandi F, Jibaja M, Amin P, Koh Y, Kuiper MA, Bulow HH, Zeggwagh AA, Anzueto A (2013) Evolution of mortality over time in patients receiving mechanical ventilation. Am J Respir Crit Care Med 188:220–230CrossRefPubMedGoogle Scholar
- 36.Papazian L, Forel JM, Gacouin A, Penot-Ragon C, Perrin G, Loundou A, Jaber S, Arnal JM, Perez D, Seghboyan JM, Constantin JM, Courant P, Lefrant JY, Guerin C, Prat G, Morange S, Roch A (2010) Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med 363:1107–1116CrossRefPubMedGoogle Scholar
- 42.Akoumianaki E, Maggiore SM, Valenza F, Bellani G, Jubran A, Loring SH, Pelosi P, Talmor D, Grasso S, Chiumello D, Guerin C, Patroniti N, Ranieri VM, Gattinoni L, Nava S, Terragni PP, Pesenti A, Tobin M, Mancebo J, Brochard L (2014) The application of esophageal pressure measurement in patients with respiratory failure. Am J Respir Crit Care Med 189:520–531CrossRefPubMedGoogle Scholar