Patient-ventilator asynchrony during non-invasive ventilation for acute respiratory failure: a multicenter study.

Détails

ID Serval
serval:BIB_1FBD300FD64B
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Patient-ventilator asynchrony during non-invasive ventilation for acute respiratory failure: a multicenter study.
Périodique
Intensive Care Medicine
Auteur(s)
Vignaux L., Vargas F., Roeseler J., Tassaux D., Thille A.W., Kossowsky M.P., Brochard Laurent, Jolliet Philippe
ISSN
1432-1238[electronic]
Statut éditorial
Publié
Date de publication
2009
Volume
35
Numéro
5
Pages
840-6
Langue
anglais
Notes
Publication types: Journal Article ; Multicenter Study
Publication Status: ppublish
Résumé
OBJECTIVE : To determine the prevalence of patient-ventilator asynchrony in patients receiving non-invasive ventilation (NIV) for acute respiratory failure. DESIGN : Prospective multicenter observation study. SETTING : Intensive care units in three university hospitals. METHODS: Patients consecutively admitted to ICU were included. NIV, performed with an ICU ventilator, was set by the clinician. Airway pressure, flow, and surface diaphragmatic electromyography were recorded continuously for 30 min. Asynchrony events and the asynchrony index (AI) were determined from visual inspection of the recordings and clinical observation. RESULTS: A total of 60 patients were included, 55% of whom were hypercapnic. Auto-triggering was present in 8 (13%) patients, double triggering in 9 (15%), ineffective breaths in 8 (13%), premature cycling 7 (12%) and late cycling in 14 (23%). An AI > 10%, indicating severe asynchrony, was present in 26 patients (43%), whose median (25-75 IQR) AI was 26 (15-54%). A significant correlation was found between the magnitude of leaks and the number of ineffective breaths and severity of delayed cycling. Multivariate analysis indicated that the level of pressure support and the magnitude of leaks were weakly, albeit significantly, associated with an AI > 10%. Patient comfort scale was higher in pts with an AI < 10%. CONCLUSION: Patient-ventilator asynchrony is common in patients receiving NIV for acute respiratory failure. Our results suggest that leaks play a major role in generating patient-ventilator asynchrony and discomfort, and point the way to further research to determine if ventilator functions designed to cope with leaks can reduce asynchrony in the clinical setting.
Mots-clé
Acute Disease, Aged, Body Mass Index, Electromyography, Female, Humans, Intensive Care Units/statistics & numerical data, Male, Patients/statistics & numerical data, Prevalence, Prospective Studies, Respiration, Artificial/statistics & numerical data, Respiratory Insufficiency/rehabilitation, Respiratory Muscles/innervation
Pubmed
Web of science
Création de la notice
29/12/2009 15:39
Dernière modification de la notice
20/08/2019 12:55
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