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Patient-Ventilator Dyssynchrony

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Personalized Mechanical Ventilation

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Abstract

Patient-ventilator dyssynchrony is a mismatch between the patient’s respiratory efforts and mechanical ventilator delivery. Dyssynchrony can occur at any phase throughout the respiratory cycle. There are different types of dyssynchrony with different mechanisms and different potential management: trigger dyssynchrony (infective efforts, auto-triggering, and double triggering); flow dyssynchrony, which happens during the inspiratory phase; and cycling dyssynchrony (premature cycling and delayed cycling). Dyssynchrony has been associated with patient outcomes. Thus, it is important to recognize and address these dyssynchronies at the bedside. Patient-ventilator dyssynchrony can be detected by carefully scrutinizing the airway pressure-time and flow-time waveforms displaying on the ventilator screens along with assessing the patient’s comfort. Clinicians need to know how to depict these dyssynchronies at the bedside. This review aims to define the different types of dyssynchrony and then discuss the evidence for their relationship with patient outcomes and address their potential management.

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Abbreviations

EAdi:

Electrical activity of the diaphragm

NAVA:

Neurally adjusted ventilatory assist

PAV:

Proportional assist ventilation

PEEPi:

Intrinsic positive end-expiratory pressure

Pes:

Esophageal pressure

TI:

Inspiratory time

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Authors and Affiliations

  1. Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE

    Bruno De Oliveira & Jihad Mallat

  2. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA

    Jihad Mallat

  3. Normandy University, UNICAEN, ED, Caen, France

    Jihad Mallat

Authors
  1. Bruno De Oliveira
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  2. Jihad Mallat
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Editor information

Editors and Affiliations

  1. Critical Care Division Belize Healthcare Partners, Belize, Belize

    Jorge Hidalgo

  2. Pulmonary and Critical Care, University of Michigan, Ann Arbor, MI, USA

    Robert C Hyzy

  3. Critical Care Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates

    Ahmed Mohamed Reda Taha

  4. Critical Care, King Faisal Specialist Hospital & Research, Riyadh, Saudi Arabia

    Yasser Younis A. Tolba

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The authors declare that they have no competing interests related to the subject of the study.

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JM and BDO participated in and wrote the manuscript.

All authors read and approved the final manuscript.

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De Oliveira, B., Mallat, J. (2022). Patient-Ventilator Dyssynchrony. In: Hidalgo, J., Hyzy, R.C., Mohamed Reda Taha, A., Tolba, Y.Y.A. (eds) Personalized Mechanical Ventilation . Springer, Cham. https://doi.org/10.1007/978-3-031-14138-6_21

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  • DOI: https://doi.org/10.1007/978-3-031-14138-6_21

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