Patient ventilator asynchrony in critically ill adults

Frequency and types

Karen G. Mellott, Mary Jo Grap, Cindy L. Munro, Curtis N. Sessler, Paul A. Wetzel, Jon O. Nilsestuen, Jessica M. Ketchum

    Research output: Contribution to journalArticle

    17 Citations (Scopus)

    Abstract

    Background: Patient ventilator asynchrony (PVA) occurs frequently, but little is known about the types and frequency of PVA. Asynchrony is associated with significant patient discomfort, distress and poor clinical outcomes (duration of mechanical ventilation, intensive care unit and hospital stay). Methods: Pressure-time and flow-time waveform data were collected on 27 ICU patients using the Noninvasive Cardiac Output monitor for up to 90min per subject and blinded waveform analysis was performed. Results: PVA occurred during all phases of ventilated breaths and all modes of ventilation. The most common type of PVA was Ineffective Trigger. Ineffective trigger occurs when the patient's own breath effort will not trigger a ventilator breath. The overall frequency of asynchronous breaths in the sample was 23%, however 93% of the sample experienced at least one incident of PVA during their observation period. Seventy-seven percent of subjects experienced multiple types of PVA. Conclusions: PVA occurs frequently in a variety of types although the majority of PVA is ineffective trigger. The study uncovered previously unidentified waveforms that may indicate that there is a greater range of PVAs than previously reported. Newly described PVA, in particular, PVA combined in one breath, may signify substantial patient distress or poor physiological circumstance that clinicians should investigate.

    Original languageEnglish (US)
    Pages (from-to)231-243
    Number of pages13
    JournalHeart and Lung: Journal of Acute and Critical Care
    Volume43
    Issue number3
    DOIs
    StatePublished - 2014

    Fingerprint

    Mechanical Ventilators
    Critical Illness
    Artificial Respiration
    Cardiac Output
    Intensive Care Units
    Ventilation
    Length of Stay

    Keywords

    • Artificial
    • Mechanical
    • Patient ventilator asynchrony
    • Patient ventilator dyssynchrony
    • Patient ventilator interaction
    • Respiration
    • Ventilators

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine
    • Critical Care and Intensive Care Medicine
    • Pulmonary and Respiratory Medicine

    Cite this

    Mellott, K. G., Grap, M. J., Munro, C. L., Sessler, C. N., Wetzel, P. A., Nilsestuen, J. O., & Ketchum, J. M. (2014). Patient ventilator asynchrony in critically ill adults: Frequency and types. Heart and Lung: Journal of Acute and Critical Care, 43(3), 231-243. https://doi.org/10.1016/j.hrtlng.2014.02.002

    Patient ventilator asynchrony in critically ill adults : Frequency and types. / Mellott, Karen G.; Grap, Mary Jo; Munro, Cindy L.; Sessler, Curtis N.; Wetzel, Paul A.; Nilsestuen, Jon O.; Ketchum, Jessica M.

    In: Heart and Lung: Journal of Acute and Critical Care, Vol. 43, No. 3, 2014, p. 231-243.

    Research output: Contribution to journalArticle

    Mellott, KG, Grap, MJ, Munro, CL, Sessler, CN, Wetzel, PA, Nilsestuen, JO & Ketchum, JM 2014, 'Patient ventilator asynchrony in critically ill adults: Frequency and types', Heart and Lung: Journal of Acute and Critical Care, vol. 43, no. 3, pp. 231-243. https://doi.org/10.1016/j.hrtlng.2014.02.002
    Mellott, Karen G. ; Grap, Mary Jo ; Munro, Cindy L. ; Sessler, Curtis N. ; Wetzel, Paul A. ; Nilsestuen, Jon O. ; Ketchum, Jessica M. / Patient ventilator asynchrony in critically ill adults : Frequency and types. In: Heart and Lung: Journal of Acute and Critical Care. 2014 ; Vol. 43, No. 3. pp. 231-243.
    @article{6a393df5f9c5402fb38278202e7a3b6b,
    title = "Patient ventilator asynchrony in critically ill adults: Frequency and types",
    abstract = "Background: Patient ventilator asynchrony (PVA) occurs frequently, but little is known about the types and frequency of PVA. Asynchrony is associated with significant patient discomfort, distress and poor clinical outcomes (duration of mechanical ventilation, intensive care unit and hospital stay). Methods: Pressure-time and flow-time waveform data were collected on 27 ICU patients using the Noninvasive Cardiac Output monitor for up to 90min per subject and blinded waveform analysis was performed. Results: PVA occurred during all phases of ventilated breaths and all modes of ventilation. The most common type of PVA was Ineffective Trigger. Ineffective trigger occurs when the patient's own breath effort will not trigger a ventilator breath. The overall frequency of asynchronous breaths in the sample was 23{\%}, however 93{\%} of the sample experienced at least one incident of PVA during their observation period. Seventy-seven percent of subjects experienced multiple types of PVA. Conclusions: PVA occurs frequently in a variety of types although the majority of PVA is ineffective trigger. The study uncovered previously unidentified waveforms that may indicate that there is a greater range of PVAs than previously reported. Newly described PVA, in particular, PVA combined in one breath, may signify substantial patient distress or poor physiological circumstance that clinicians should investigate.",
    keywords = "Artificial, Mechanical, Patient ventilator asynchrony, Patient ventilator dyssynchrony, Patient ventilator interaction, Respiration, Ventilators",
    author = "Mellott, {Karen G.} and Grap, {Mary Jo} and Munro, {Cindy L.} and Sessler, {Curtis N.} and Wetzel, {Paul A.} and Nilsestuen, {Jon O.} and Ketchum, {Jessica M.}",
    year = "2014",
    doi = "10.1016/j.hrtlng.2014.02.002",
    language = "English (US)",
    volume = "43",
    pages = "231--243",
    journal = "Heart and Lung: Journal of Acute and Critical Care",
    issn = "0147-9563",
    publisher = "Mosby Inc.",
    number = "3",

    }

    TY - JOUR

    T1 - Patient ventilator asynchrony in critically ill adults

    T2 - Frequency and types

    AU - Mellott, Karen G.

    AU - Grap, Mary Jo

    AU - Munro, Cindy L.

    AU - Sessler, Curtis N.

    AU - Wetzel, Paul A.

    AU - Nilsestuen, Jon O.

    AU - Ketchum, Jessica M.

    PY - 2014

    Y1 - 2014

    N2 - Background: Patient ventilator asynchrony (PVA) occurs frequently, but little is known about the types and frequency of PVA. Asynchrony is associated with significant patient discomfort, distress and poor clinical outcomes (duration of mechanical ventilation, intensive care unit and hospital stay). Methods: Pressure-time and flow-time waveform data were collected on 27 ICU patients using the Noninvasive Cardiac Output monitor for up to 90min per subject and blinded waveform analysis was performed. Results: PVA occurred during all phases of ventilated breaths and all modes of ventilation. The most common type of PVA was Ineffective Trigger. Ineffective trigger occurs when the patient's own breath effort will not trigger a ventilator breath. The overall frequency of asynchronous breaths in the sample was 23%, however 93% of the sample experienced at least one incident of PVA during their observation period. Seventy-seven percent of subjects experienced multiple types of PVA. Conclusions: PVA occurs frequently in a variety of types although the majority of PVA is ineffective trigger. The study uncovered previously unidentified waveforms that may indicate that there is a greater range of PVAs than previously reported. Newly described PVA, in particular, PVA combined in one breath, may signify substantial patient distress or poor physiological circumstance that clinicians should investigate.

    AB - Background: Patient ventilator asynchrony (PVA) occurs frequently, but little is known about the types and frequency of PVA. Asynchrony is associated with significant patient discomfort, distress and poor clinical outcomes (duration of mechanical ventilation, intensive care unit and hospital stay). Methods: Pressure-time and flow-time waveform data were collected on 27 ICU patients using the Noninvasive Cardiac Output monitor for up to 90min per subject and blinded waveform analysis was performed. Results: PVA occurred during all phases of ventilated breaths and all modes of ventilation. The most common type of PVA was Ineffective Trigger. Ineffective trigger occurs when the patient's own breath effort will not trigger a ventilator breath. The overall frequency of asynchronous breaths in the sample was 23%, however 93% of the sample experienced at least one incident of PVA during their observation period. Seventy-seven percent of subjects experienced multiple types of PVA. Conclusions: PVA occurs frequently in a variety of types although the majority of PVA is ineffective trigger. The study uncovered previously unidentified waveforms that may indicate that there is a greater range of PVAs than previously reported. Newly described PVA, in particular, PVA combined in one breath, may signify substantial patient distress or poor physiological circumstance that clinicians should investigate.

    KW - Artificial

    KW - Mechanical

    KW - Patient ventilator asynchrony

    KW - Patient ventilator dyssynchrony

    KW - Patient ventilator interaction

    KW - Respiration

    KW - Ventilators

    UR - http://www.scopus.com/inward/record.url?scp=84899671778&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=84899671778&partnerID=8YFLogxK

    U2 - 10.1016/j.hrtlng.2014.02.002

    DO - 10.1016/j.hrtlng.2014.02.002

    M3 - Article

    VL - 43

    SP - 231

    EP - 243

    JO - Heart and Lung: Journal of Acute and Critical Care

    JF - Heart and Lung: Journal of Acute and Critical Care

    SN - 0147-9563

    IS - 3

    ER -