Asynchronies during mechanical ventilation are associated with mortality
| Autor: | Robert M. Kacmarek, Manel Luján, Joan Carles Oliva, Lluis Blanch, Ana Villagrá, Encarna Chacón, Enrique Fernández-Mondéjar, Bernat Sales, Umberto Lucangelo, Rafael Fernandez, Jaume Montanya, Oscar Garcia-Esquirol, Jesús Villar, Josefina López-Aguilar, Guillermo M. Albaiceta, Anna Estruga, Alberto Hernandez-Abadia, Gastón Murias |
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| Přispěvatelé: | Blanch, Lluí, Villagra, Ana, Sales, Bernat, Montanya, Jaume, Lucangelo, Umberto, Luján, Manel, García Esquirol, Oscar, Chacón, Encarna, Estruga, Anna, Oliva, Joan C., Hernández Abadia, Alberto, Albaiceta, Guillermo M., Fernández Mondejar, Enrique, Fernández, Rafael, Lopez Aguilar, Josefina, Villar, Jesú, Murias, Gastón, Kacmarek, Robert M. |
| Jazyk: | angličtina |
| Rok vydání: | 2015 |
| Předmět: |
medicine.medical_specialty
Time Factors Time Factor medicine.medical_treatment Critical Illness Intensive Care Unit Hospital mortality Respiratory physiology Critical Care and Intensive Care Medicine law.invention Mechanical ventilation law Anesthesiology medicine Tidal Volume Humans Prospective Studies Hospital Mortality Mortality Prospective cohort study Patient–ventilator asynchrony Tidal volume Respiratory Mechanic business.industry Respiratory monitoring Respiration Medicine (all) Intensive care unit Respiration Artificial Intensive Care Units Prospective Studie Pulmonary Ventilation Respiratory Mechanics Anesthesia Artificial Critical Illne business Interactive Ventilatory Support Human |
| Popis: | This study aimed to assess the prevalence and time course of asynchronies during mechanical ventilation (MV). Prospective, noninterventional observational study of 50 patients admitted to intensive care unit (ICU) beds equipped with Better Care (TM) 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. 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 a parts per thousand currency sign 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. 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. |
| Databáze: | OpenAIRE |
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