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Intensive Care Med. 2015 Apr;41(4):633-41. doi: 10.1007/s00134-015-3692-6. Epub 2015 Feb 19.

Asynchronies during mechanical ventilation are associated with mortality.

Author information

1
Critical Care Center, Hospital de Sabadell, Corporació Sanitaria Universitària Parc Taulí, Universitat Autònoma de Barcelona, Parc Taulí, 1, 08208, Sabadell, Spain, LBlanch@tauli.cat.

Abstract

PURPOSE:

This study aimed to assess the prevalence and time course of asynchronies during mechanical ventilation (MV).

METHODS:

Prospective, noninterventional observational study of 50 patients admitted to intensive care unit (ICU) beds equipped with Better Care™ software throughout MV. The software distinguished ventilatory modes and detected ineffective inspiratory efforts during expiration (IEE), double-triggering, aborted inspirations, and short and prolonged cycling to compute the asynchrony index (AI) for each hour. We analyzed 7,027 h of MV comprising 8,731,981 breaths.

RESULTS:

Asynchronies were detected in all patients and in all ventilator modes. The median AI was 3.41 % [IQR 1.95-5.77]; the most common asynchrony overall and in each mode was IEE [2.38 % (IQR 1.36-3.61)]. Asynchronies were less frequent from 12 pm to 6 am [1.69 % (IQR 0.47-4.78)]. In the hours where more than 90 % of breaths were machine-triggered, the median AI decreased, but asynchronies were still present. When we compared patients with AI > 10 vs AI ≤ 10 %, we found similar reintubation and tracheostomy rates but higher ICU and hospital mortality and a trend toward longer duration of MV in patients with an AI above the cutoff.

CONCLUSIONS:

Asynchronies are common throughout MV, occurring in all MV modes, and more frequently during the daytime. Further studies should determine whether asynchronies are a marker for or a cause of mortality.

PMID:
25693449
DOI:
10.1007/s00134-015-3692-6
[Indexed for MEDLINE]

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