Patient-ventilator asynchrony.
The basic mechanism of patient-ventilator asynchrony is the mismatching between neural inspiratory and mechanical inspiratory time. Alterations in respiratory drive, timing, respiratory muscle pressure, and respiratory system mechanics influence the interaction between the patient and the ventilator. None of the currently available partial ventilatory support modes are exempt from problems with patient-ventilator asynchrony. Ventilator triggering design in the trigger phase and the set variables in the post-trigger phase contribute to patient-ventilator interaction. The set inspiratory flow rate in the post-trigger phase for assist-control volume cycled ventilation affects patient-ventilator asynchrony. Likewise, the initial pressure rise time, the pressure support level, and the flow-threshold for cycling off inspiration for pressure support ventilation are important factors affecting patient-ventilator asynchrony. Current investigations have advanced our understanding in this area; however, its prevalence and the extent to which patient-ventilator asynchrony affect the duration of mechanical ventilation remain unclear.
Sassoon
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Department of Medicine, Long Beach VA Health Care System, (111P), 5901 East Seventh Street, Long Beach, CA 90822, USA. catherine.sassoon@med.va.gov
Foster
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D006801:Humans; D007320:Inspiratory Capacity; D012123:Pulmonary Ventilation; D012121:Respiration, Artificial / Q000379:methods* / Q000592:standards; D013990:Tidal Volume; D012122:Ventilators, Mechanical / Q000592:standards / Q000600:supply & distribution