Patient–ventilator asynchrony in acute brain-injured patients: a prospective observational study

• Published in: Annals of intensive care 2020-10, Vol.10 (1), p.144-144, Article 144
• Main Authors: Luo, Xu-Ying, He, Xuan, Zhou, Yi-Min, Wang, Yu-Mei, Chen, Jing-Ran, Chen, Guang-Qiang, Li, Hong-Liang, Yang, Yan-Lin, Zhang, Linlin, Zhou, Jian-Xin
• Format: Article
• Language: English
• Subjects: Anesthesiology; Asynchrony; Brain injury; Critical Care Medicine; Emergency Medicine; Intensive; Mechanical ventilation; Medicine; Medicine & Public Health; Monitoring; NCT; NCT03212482; Prevalence; Severity
• ISSN: 2110-5820; 2110-5820
• DOI: 10.1186/s13613-020-00763-8

Background Patient–ventilator asynchrony is common in mechanically ventilated patients and may be related to adverse outcomes. Few studies have reported the occurrence of asynchrony in brain-injured patients. We aimed to investigate the prevalence, type and severity of patient–ventilator asynchrony in mechanically ventilated patients with brain injury. Methods This prospective observational study enrolled acute brain-injured patients undergoing mechanical ventilation. Esophageal pressure monitoring was established after enrollment. Flow, airway pressure, and esophageal pressure–time waveforms were recorded for a 15-min interval, four times daily for 3 days, for visually detecting asynchrony by offline analysis. At the end of each dataset recording, the respiratory drive was determined by the airway occlusion maneuver. The asynchrony index was calculated to represent the severity. The relationship between the prevalence and the severity of asynchrony with ventilatory modes and settings, respiratory drive, and analgesia and sedation were determined. Association of severe patient–ventilator asynchrony, which was defined as an asynchrony index  ≥ 10%, with clinical outcomes was analyzed. Results In 100 enrolled patients, a total of 1076 15-min waveform datasets covering 330,292 breaths were collected, in which 70,156 (38%) asynchronous breaths were detected. Asynchrony occurred in 96% of patients with the median (interquartile range) asynchrony index of 12.4% (4.3%–26.4%). The most prevalent type was ineffective triggering. No significant difference was found in either prevalence or asynchrony index among different classifications of brain injury ( p  > 0.05). The prevalence of asynchrony was significantly lower during pressure control/assist ventilation than during other ventilatory modes ( p