Optimizing patient-ventilator synchrony during invasive ventilator assist in children and infants remains a difficult task.

Détails

ID Serval
serval:BIB_4EEF9A5CAB82
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Optimizing patient-ventilator synchrony during invasive ventilator assist in children and infants remains a difficult task.
Périodique
Pediatric Critical Care Medicine
Auteur(s)
Vignaux L., Grazioli S., Piquilloud L., Bochaton N., Karam O., Jaecklin T., Levy-Jamet Y., Tourneux P., Jolliet P., Rimensberger P.C.
ISSN
1529-7535 (Print)
ISSN-L
1529-7535
Statut éditorial
Publié
Date de publication
2013
Peer-reviewed
Oui
Volume
14
Numéro
7
Pages
e316-e325
Langue
anglais
Notes
Publication types: Journal ArticlePublication Status: ppublish
Résumé
OBJECTIVES: To document and compare the prevalence of asynchrony events during invasive-assisted mechanical ventilation in pressure support mode and in neurally adjusted ventilatory assist in children.
DESIGN: Prospective, randomized, and crossover study.
SETTING: Pediatric and Neonatal Intensive Care Unit, University Hospital of Geneva, Switzerland.
PATIENTS: Intubated and mechanically ventilated children, between 4 weeks and 5 years old.
INTERVENTIONS: Two consecutive ventilation periods (pressure support and neurally adjusted ventilatory assist) were applied in random order. During pressure support, three levels of expiratory trigger setting were compared: expiratory trigger setting as set by the clinician in charge (PSinit), followed by a 10% (in absolute values) increase and decrease of the clinician's expiratory trigger setting. The pressure support session with the least number of asynchrony events was defined as PSbest. Therefore, three periods were compared: PSinit, PSbest, and neurally adjusted ventilatory assist. Asynchrony events, trigger delay, and inspiratory time in excess were quantified for each of them.
MEASUREMENTS AND MAIN RESULTS: Data from 19 children were analyzed. Main asynchrony events during PSinit were autotriggering (3.6 events/min [0.7-8.2]), ineffective efforts (1.2/min [0.6-5]), and premature cycling (3.5/min [1.3-4.9]). Their number was significantly reduced with PSbest: autotriggering 1.6/min (0.2-4.9), ineffective efforts 0.7/min (0-2.6), and premature cycling 2/min (0.1-3.1), p < 0.005 for each comparison. The median asynchrony index (total number of asynchronies/triggered and not triggered breaths ×100) was significantly different between PSinit and PSbest: 37.3% [19-47%] and 29% [24-43%], respectively, p < 0.005). With neurally adjusted ventilatory assist, all types of asynchrony events except double-triggering and inspiratory time in excess were significantly reduced resulting in an asynchrony index of 3.8% (2.4-15%) (p < 0.005 compared to PSbest).
CONCLUSIONS: Asynchrony events are frequent during pressure support in children despite adjusting the cycling off criteria. Neurally adjusted ventilatory assist allowed for an almost ten-fold reduction in asynchrony events. Further studies should determine the clinical impact of these findings.
Pubmed
Web of science
Création de la notice
17/11/2013 18:22
Dernière modification de la notice
11/10/2019 19:53
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