Impact of Minimizing Asynchronies in Mechanical Ventilation on Patient’s Outcome in Pediatric Intensive Care Unit
Asian Journal of Pediatric Research,
Page 47-55
DOI:
10.9734/ajpr/2022/v10i4206
Abstract
Background: Patients-ventilator asynchrony defined as a mismatch between the patient’s respiratory effort and the ventilator delivered breaths and it is common in clinical practice. Patient ventilator interaction is a key element in optimizing MV. The change from inspiration to expiration is a crucial point in the mechanically ventilated breaths and is termed cycling, PVA may occur if the flow at which the ventilator cycles to exhalation does not coincide with the termination of neural inspiration. Ideally, the ventilator terminates inspiratory flow in synchrony with the patients neural timing, but frequently the ventilator terminates early or late.
Aims: The aim of this study was to detect the prevalence of asynchrony during assisted MV, IT and DT were the two main patterns of asynchrony.
Patients and Methods: This prospective study was carried out upon 60 patients from 2 to 180 months, 38 males and 22 females, with spontaneous triggering on MV, admitted to the PICU, Tanta University Hospital.
Results: Fortunately, ITI is increased with volume SIMV +PSV compared with pressure SIMV +PSV and PRVC. ITI is a highly significant diagnostic for synchronization. Pressure regulated volume control was better than pressure SIMV+PSV and both were better than volume SIMV +PSV proved by less ITI and increase mortality with ITI ≥10%.
Conclusion: Pressure regulated volume control was better than pressure SIMV+PSV and both were better than volume SIMV +PSV proved by less ITI and increase mortality with ITI ≥10%. The patient-ventilator synchrony is crucial in determining the patient comfort, MV duration, and survival ITI is diagnostic for synchronization. ITI, PIP/ITI on 1st day, and SpO2 on 3rd day were significant predictors for synchronization.
Keywords:
- Asynchronies
- mechanical ventilation
- pediatric
- PICU
How to Cite
References
Mauri T, Yoshida T, Bellani G, Goligher EC, Carteaux G, Rittayamai N, et al.; Pleural pressure working Group (PLUG—Acute Respiratory Failure section of the European Society of Intensive Care Medicine). Esophageal and transpulmonary pressure in the clinical setting: meaning, usefulness and perspectives. Intensive Care Med. 2016;42(9):1360-60.
Thille AW, Rodriguez P, Cabello B, Lellouche F, Brochard L.; Patient-ventilator asynchrony during assisted mechanical ventilation. Intensive Care Med. 2006; 32(10):1515-22.
Blanch L, Villagra A, Sales B, Montanya J, Lucangelo U, Luja´n M, et al.; Asynchronies during mechanical ventilation are associated with mortality. Intensive Care Med 2015;41(4): 633-41.
Vaporidi K, Babalis D, Chytas A, Lilitsis E, Kondili E, Amargianitakis V, et al.; Clusters of ineffective efforts during mechanical ventilation: impact on outcome. Intensive Care Med 2017;43(2):84-91.
Gilstrap D, MacIntyre N.; Patient–ventilator interactions. Implications for clinical management. Am J Respir Crit Care Med. 2013;150(4):896-903.
Murias G, Villagra A, Blanch L.; Patient-ventilator desynchrony during assisted invasive mechanical ventilation. Minerva Anestesiol 2013;79(4):34-44.
Kallet RH.; Patient-ventilator interaction during acute lung injury, and the role of spontaneous breathing: part 1: respiratory muscle function during critical illness. Respir Care 2011;56(2): 81-89.
Sassoon CS. Triggering of the ventilator in patient-ventilator interactions. Respir Care 2011;56(1):39-51.
Georgopoulos D, Prinianakis G, Kondili E.; Bedside waveforms interpretation as a tool to identify patient-ventilator asynchronies. Intensive Care Med 2006; 32(1):34-47.
Mishra P, Pandey CM, Singh U, Gupta A, Sahu C and Keshri A. Descriptive statistics and normality tests for statistical data. Ann Card Anaesth. 2019;22(1): 67-72.
Mishra P, Singh U, Pandey CM, Mishra P and Pandey G. Application of student's t-test, analysis of variance, and covariance. Ann Card Anaesth. 2019;22(4): 407-11.
Vermeulen K, Thas O, Vansteelandt S. Increasing the power of the Mann-Whitney test in randomized experiments through flexible covariate adjustment. Stat Med. 2015;34(6):1012-30.
Pandis N. The chi-square test. Am J Orthod Dentofacial Orthop. 2016;150(5): 898-9.
Shen J and He X. Generalized F test and generalized deviance test in two-way ANOVA models for randomized trials. J Biopharm Stat. 2014;24(3): 523-34.
Vignaux L, Vargas F, Roeseler J, Tassaux D, Thille AW,Kossowsky MP, et al. Patient-ventilator asynchrony during non-invasive ventilation for acute respiratory failure: a multicenter study. Intensive Care Med. 2009;35(5): 840-6.
Ostermann ME, Keenan SP, Seiferling RA, Sibbald WJ. Sedation in the intensive care unit: a systematic review. JAMA. 2000; 283:1451-9.
Fabry B, Guttman J, Eberhard L, Bauer T, Haberthur C, Wolff G, et al. An analysis of dysynchornization between the spontaneously breathing patient and ventilator during inspiratory pressure support. Chest. 1995;107(5):1387-94.
Vitacca M, Bianchi L, Zanotti E, Vianello A, Barbano L, Porta R, et al. Assessment of physiologic variables and subjective comfort under different levels of pressure support ventilation. Chest. 2004;126: 851-9.
Purro A, Appedini L,Degateono A. Appedini L, A physiological determinants of ventilator dependence in long term mechanically ventilated patients. Am J Respir Crit Care Med. 2000;161(4pt1): 1115-23.
Tassaux D, Gainnier M, Battisti A, Jolliet P. Impact of expiratory trigger setting on delayed cycling and inspiratory muscle workload. Am J Respir Crit Care Med. 2005;172(10):1283-9.
Thille AW, Cabello B, Galia F, Lyazidi A, Brochard L. Reduction of patient- ventilator asynchrony by reducing tidal volume during pressure support ventilation. Intensive Care Med. 2005;172(10):1283-9.
Pohlman MC, Mc Callister KE, Schweickert WD, Pohlman AS, Nigos CP, Krishman JA, et al. Excessive tidal volume from breath stacking during lung protective ventilation for acute lung injury. Crit. Care Med. 2008;36(11):3019-23.
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