REVIEW   Free access

Minerva Anestesiologica 2019 June;85(6):676-88

DOI: 10.23736/S0375-9393.19.13436-0

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Patient-ventilator asynchrony in adult critically ill patients

Andrea BRUNI ¹, Eugenio GAROFALO ¹, Corrado PELAIA ¹, Antonio MESSINA ², Gianmaria CAMMAROTA ³, Paolo MURABITO ⁴, Silvia CORRADO ¹, Luigi VETRUGNO ⁵, Federico LONGHINI ¹ ✉, Paolo NAVALESI ¹

¹ Intensive Care Unit, Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, Catanzaro, Italy; ² IRCCS Humanitas, Humanitas University, Milan, Italy; ³ Unit of Anesthesia and Intensive Care, “Maggiore della Carità” Hospital, Novara, Italy; ⁴ Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia”, “G. Rodolico” University Policlinic, University of Catania, Catania, Italy; ⁵ Department of Anesthesia and Intensive Care, University of Udine, Udine, Italy

INTRODUCTION: Patient-ventilator asynchrony is considered a major clinical problem for mechanically ventilated patients. It occurs during partial ventilatory support, when the respiratory muscles and the ventilator interact to contribute generating the volume output. In this review article, we consider all studies published on patient-ventilator asynchrony in the last 25 years.
EVIDENCE ACQUISITION: We selected 62 studies. The different forms of asynchrony are first defined and classified. We also describe the methods used for detecting and quantifying asynchronies. We then outline the outcome variables considered for evaluating the clinical consequences of asynchronies. The methodology for detection and quantification of patient-ventilator asynchrony are quite heterogeneous. In particular, the Asynchrony Index is calculated differently among studies.
EVIDENCE SYNTHESIS: Sixteen studies established some relationship between asynchronies and one or more clinical outcomes, such as duration of mechanical ventilation (seven studies), mortality (five studies), length of intensive care and hospital stay (four studies), patient comfort (four studies), quality of sleep (three studies), and rate of tracheotomy (three studies). In patients with severe patient-ventilator asynchrony, four of seven studies (57%) report prolonged duration of mechanical ventilation, one of five (20%) increased mortality, one of four (25%) longer intensive care and hospital lengths of stay, four of four (100%) worsened comfort, three of four (75%) deteriorated quality of sleep, and one of three (33%) increased rate of tracheotomy.
CONCLUSIONS: Given the varying outcomes considered and the erratic results, it remains unclear whether asynchronies really affects patient outcome, and the relationship between asynchronies and outcome is causative or associative.

KEY WORDS: Respiration, artificial; Interactive ventilatory support; Treatment outcome