Andrea Bruni1, Eugenio Garofalo1, Corrado Pelaia1, Antonio Messina2, Gianmaria Cammarota3, Paolo Murabito4, Silvia Corrado1, Luigi Vetrugno5, Federico Longhini6, Paolo Navalesi1. 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. 6. Intensive Care Unit, Department of Medical and Surgical Sciences, University Hospital Mater Domini, Magna Graecia University, Catanzaro, Italy - longhini.federico@gmail.com.
Abstract
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.
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.
Authors: Brian Murray; Andrea Sikora; Jason R Mock; Thomas Devlin; Kelli Keats; Rebecca Powell; Thomas Bice Journal: Front Pharmacol Date: 2022-06-22 Impact factor: 5.988
Authors: Andrea Bruni; Eugenio Garofalo; Valeria Zuccalà; Giuseppe Currò; Carlo Torti; Giuseppe Navarra; Giovambattista De Sarro; Paolo Navalesi; Federico Longhini; Michele Ammendola Journal: World J Emerg Surg Date: 2020-07-02 Impact factor: 5.469
Authors: F Longhini; A Bruni; E Garofalo; P Navalesi; G Grasselli; R Cosentini; G Foti; A Mattei; M Ippolito; G Accurso; F Vitale; A Cortegiani; C Gregoretti Journal: Pulmonology Date: 2020-04-30
Authors: Gianmaria Cammarota; Federico Verdina; Nello De Vita; Ester Boniolo; Riccardo Tarquini; Antonio Messina; Marta Zanoni; Paolo Navalesi; Luigi Vetrugno; Elena Bignami; Francesco Della Corte; Edoardo De Robertis; Erminio Santangelo; Rosanna Vaschetto Journal: J Clin Monit Comput Date: 2021-02-09 Impact factor: 1.977
Authors: Yongfang Zhou; Steven R Holets; Man Li; Gustavo A Cortes-Puentes; Todd J Meyer; Andrew C Hanson; Phillip J Schulte; Richard A Oeckler Journal: Sci Rep Date: 2021-06-11 Impact factor: 4.379