Ventilator-patient dyssynchrony induced by change in ventilation mode.
Patient-ventilator interactions may be coordinated (synchronous) or uncoordinated (dyssynchronous). Ventilator-patient dyssynchrony increases the work of breathing by imposing a respiratory muscle workload. Respiratory centre output responds to feedback from respiratory muscle loading. Mismatching of respiratory centre output and mechanical assistance results in dyssynchrony. We describe a case of severe patient-ventilator dyssynchrony and hypothesize that dyssynchrony was induced by a change in mode of ventilation from pressure-cycled to volume-cycled ventilation, due to both ventilator settings and by the patient's own respiratory centre adaptation to mechanical ventilation. The causes, management and clinical implications of dyssynchrony are discussed.
Lydon
A M
AM
Department of Anaesthesia and Intensive Care Medicine, Adelaide and Meath Hospital, National Children's Hospital, Tallaght, Dublin, Ireland.
Doyle
M
M
Donnelly
M B
MB
D000368:Aged; D005260:Female; D006801:Humans; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D012125:Respiratory Center / Q000502:physiology; D012128:Respiratory Distress Syndrome / Q000628:therapy; D012122:Ventilators, Mechanical; D014939:Work of Breathing