title: Asynchronies during mechanical ventilation are associated with mortality.
abstract: OBJECTIVE
  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.
authors.affiliation: Critical Care Center, Hospital de Sabadell, Corporació Sanitaria Universitària Parc Taulí, Universitat Autònoma de Barcelona, Parc Taulí, 1, 08208, Sabadell, Spain, LBlanch@tauli.cat.
authors.forename: Lluís
authors.initials: L
authors.lastname: Blanch
authors.forename: Ana
authors.initials: A
authors.lastname: Villagra
authors.forename: Bernat
authors.initials: B
authors.lastname: Sales
authors.forename: Jaume
authors.initials: J
authors.lastname: Montanya
authors.forename: Umberto
authors.initials: U
authors.lastname: Lucangelo
authors.forename: Manel
authors.initials: M
authors.lastname: Luján
authors.forename: Oscar
authors.initials: O
authors.lastname: García-Esquirol
authors.forename: Encarna
authors.initials: E
authors.lastname: Chacón
authors.forename: Anna
authors.initials: A
authors.lastname: Estruga
authors.forename: Joan C
authors.initials: JC
authors.lastname: Oliva
authors.forename: Alberto
authors.initials: A
authors.lastname: Hernández-Abadia
authors.forename: Guillermo M
authors.initials: GM
authors.lastname: Albaiceta
authors.forename: Enrique
authors.initials: E
authors.lastname: Fernández-Mondejar
authors.forename: Rafael
authors.initials: R
authors.lastname: Fernández
authors.forename: Josefina
authors.initials: J
authors.lastname: Lopez-Aguilar
authors.forename: Jesús
authors.initials: J
authors.lastname: Villar
authors.forename: Gastón
authors.initials: G
authors.lastname: Murias
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kacmarek
mesh_terms: D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D011446:Prospective Studies; D012123:Pulmonary Ventilation; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000401:mortality; D015656:Respiratory Mechanics; D013990:Tidal Volume; D013997:Time Factors