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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2017

Open Access 01-12-2017 | Research

Patient–ventilator asynchrony during conventional mechanical ventilation in children

Authors: Guillaume Mortamet, Alexandrine Larouche, Laurence Ducharme-Crevier, Olivier Fléchelles, Gabrielle Constantin, Sandrine Essouri, Amélie-Ann Pellerin-Leblanc, Jennifer Beck, Christer Sinderby, Philippe Jouvet, Guillaume Emeriaud

Published in: Annals of Intensive Care | Issue 1/2017

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Abstract

Background

We aimed (1) to describe the characteristics of patient–ventilator asynchrony in a population of critically ill children, (2) to describe the risk factors associated with patient–ventilator asynchrony, and (3) to evaluate the association between patient–ventilator asynchrony and ventilator-free days at day 28.

Methods

In this single-center prospective study, consecutive children admitted to the PICU and mechanically ventilated for at least 24 h were included. Patient–ventilator asynchrony was analyzed by comparing the ventilator pressure curve and the electrical activity of the diaphragm (Edi) signal with (1) a manual analysis and (2) using a standardized fully automated method.

Results

Fifty-two patients (median age 6 months) were included in the analysis. Eighteen patients had a very low ventilatory drive (i.e., peak Edi < 2 µV on average), which prevented the calculation of patient–ventilator asynchrony. Children spent 27% (interquartile 22–39%) of the time in conflict with the ventilator. Cycling-off errors and trigger delays contributed to most of this asynchronous time. The automatic algorithm provided a NeuroSync index of 45%, confirming the high prevalence of asynchrony. No association between the severity of asynchrony and ventilator-free days at day 28 or any other clinical secondary outcomes was observed, but the proportion of children with good synchrony was very low.

Conclusion

Patient–ventilator interaction is poor in children supported by conventional ventilation, with a high frequency of depressed ventilatory drive and a large proportion of time spent in asynchrony. The clinical benefit of strategies to improve patient–ventilator interactions should be evaluated in pediatric critical care.
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Metadata
Title
Patient–ventilator asynchrony during conventional mechanical ventilation in children
Authors
Guillaume Mortamet
Alexandrine Larouche
Laurence Ducharme-Crevier
Olivier Fléchelles
Gabrielle Constantin
Sandrine Essouri
Amélie-Ann Pellerin-Leblanc
Jennifer Beck
Christer Sinderby
Philippe Jouvet
Guillaume Emeriaud
Publication date
01-12-2017
Publisher
Springer International Publishing
Published in
Annals of Intensive Care / Issue 1/2017
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-017-0344-8

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