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Ann Thorac Med. 2020 Jan-Mar;15(1):1-8. doi: 10.4103/atm.ATM_24_19. Epub 2020 Jan 2.

Ventilator- and interface-related factors influencing patient-ventilator asynchrony during noninvasive ventilation.

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Department of Clinical Sciences, University of Sharjah, Sharjah, UAE.
Department of Medicine, The University Sleep Disorders Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.


Patient-ventilator asynchrony (PVA) is common in patients receiving noninvasive ventilation (NIV). This occurs primarily when the triggering and cycling-off of ventilatory assistance are not synchronized with the patient's inspiratory efforts and could result in increased work of breathing and niv failure. In general, five types of asynchrony can occur during NIV: ineffective inspiratory efforts, double-triggering, auto-triggering, short-ventilatory cycling, and long-ventilatory cycling. Many factors that affect PVA are mostly related to the degree of air leakage, level of pressure support, and the type and properties of the interface used. Careful monitoring and adjustment of these factors are essential to reduce PVA and improve patient comfort. In this article, we discuss the machine and interface-related factors that influence PVA during NIV and its effect on the respiratory mechanics during pressure support ventilation, which is the ventilatory mode used most commonly during NIV. For that, we critically evaluated studies that assessed ventilator- and interface-related factors that influence PVA during NIV and proposed therapeutic solutions.


Air leak; humidity; interface; noninvasive ventilation; patient-ventilator synchrony

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