Intensive Care Medicine

, Volume 41, Issue 4, pp 633–641 | Cite as

Asynchronies during mechanical ventilation are associated with mortality

  • Lluís Blanch
  • Ana Villagra
  • Bernat Sales
  • Jaume Montanya
  • Umberto Lucangelo
  • Manel Luján
  • Oscar García-Esquirol
  • Encarna Chacón
  • Anna Estruga
  • Joan C. Oliva
  • Alberto Hernández-Abadia
  • Guillermo M. Albaiceta
  • Enrique Fernández-Mondejar
  • Rafael Fernández
  • Josefina Lopez-Aguilar
  • Jesús Villar
  • Gastón Murias
  • Robert M. Kacmarek
Original

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.

Keywords

Patient–ventilator asynchrony Mechanical ventilation Mortality Respiratory monitoring 

Supplementary material

134_2015_3692_MOESM1_ESM.doc (298 kb)
Supplementary material 1 (DOC 298 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2015

Authors and Affiliations

  • Lluís Blanch
    • 1
    • 2
    • 3
  • Ana Villagra
    • 1
    • 2
  • Bernat Sales
    • 2
    • 3
  • Jaume Montanya
    • 2
    • 3
  • Umberto Lucangelo
    • 4
  • Manel Luján
    • 2
    • 5
  • Oscar García-Esquirol
    • 1
    • 3
  • Encarna Chacón
    • 1
  • Anna Estruga
    • 1
  • Joan C. Oliva
    • 3
  • Alberto Hernández-Abadia
    • 6
  • Guillermo M. Albaiceta
    • 2
    • 7
    • 8
  • Enrique Fernández-Mondejar
    • 9
  • Rafael Fernández
    • 2
    • 10
  • Josefina Lopez-Aguilar
    • 1
    • 2
    • 3
  • Jesús Villar
    • 2
    • 11
  • Gastón Murias
    • 12
  • Robert M. Kacmarek
    • 13
    • 14
  1. 1.Critical Care Center, Hospital de Sabadell, Corporació Sanitaria Universitària Parc TaulíUniversitat Autònoma de BarcelonaSabadellSpain
  2. 2.CIBER Enfermedades RespiratoriasISCIIIMadridSpain
  3. 3.Fundació Parc Taulí, Corporació Sanitaria Universitària Parc TaulíUniversitat Autònoma de BarcelonaSabadellSpain
  4. 4.Department of Perioperative Medicine, Intensive Care and Emergency, Cattinara HospitalTrieste UniversityTriesteItaly
  5. 5.Department of Pneumology, Hospital de Sabadell, Corporació Sanitària Universitària Parc TaulíUniversitat Autònoma de BarcelonaSabadellSpain
  6. 6.Hospital Central de la Defensa Gomez UllaMadridSpain
  7. 7.Department of Functional BiologyUniversidad de OviedoOviedoSpain
  8. 8.Department of Critical CareHospital Central de AsturiasOviedoSpain
  9. 9.Department of Emergency and Critical Care Medicine, Hospital Virgen de las NievesUniversidad de GranadaGranadaSpain
  10. 10.Servei de Medicina Intensiva, Fundacio AlthaiaUniversitat Internacional de CatalunyaManresaSpain
  11. 11.Research Unit, Multidisciplinary Organ Dysfunction Evaluation Research Network (MODERN)Hospital Universitario Dr. NegrínLas Palmas De Gran CanariaSpain
  12. 12.Clínica Bazterrica y Clínica Santa IsabelBuenos AiresArgentina
  13. 13.Department of Respiratory CareMassachusetts General HospitalBostonUSA
  14. 14.Department of AnesthesiologyHarvard Medical SchoolBostonUSA

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