Incidence

Up to 25% of patients with acute respiratory failure exhibit a significant proportion of asynchronous breaths (>10 %)([FOOTNOTE=Robinson BR, Blakeman TC, Toth P, Hanseman DJ, Mueller E, Branson RD. Patient-ventilator asynchrony in a traumatically injured population. Respiratory care. 2013;58(11):1847-1855.],[ANCHOR=View Abstract],[LINK=/content/covidien/websites/medtronic/com/en/covidien/support/clinical-evidence.html?id=1203233])

Clinical Impact

Exhibiting a significant proportion of asynchronous breaths is associated with an almost five-fold increase in ICU mortality,1 a three-fold increase in median duration of mechanical ventilation and a greater than two-fold increase in median hospital length of stay.2

Etiology

Patient-ventilator asynchrony consists of multiple types of asynchrony. The identification and treatment of each type is multifactorial, influenced by a myriad of ventilator-related and patient-specific factors.([FOOTNOTE=Pierson DJ. Patient-ventilator interaction. Respiratory care. 2011;56(2):214-228.],[ANCHOR=View Abstract],[LINK=/content/covidien/websites/medtronic/com/en/covidien/support/clinical-evidence.html?id=1203232])

Interventions

Features included in the Puritan Bennettâ„¢ 980 ventilator may help improve patient synchrony by better aligning triggering, flow, breath delivery, and cycling with individualized patient need, promoting more natural breathing compared to conventional mechanical ventilation.([FOOTNOTE=Xirouchaki N, Kondili E, Vaporidi K, et al. Proportional assist ventilation with load-adjustable gain factors in critically ill patients: comparison with pressure support. Intensive care medicine. 2008;34(11):2026-2034.],[ANCHOR=View Abstract],[LINK=/content/covidien/websites/medtronic/com/en/covidien/support/clinical-evidence.html?id=719462 ])

Outcomes

Reduction of asynchrony with the Puritan Bennett 980 ventilator may improve patient outcomes compared to PS and VC.([FOOTNOTE=Bosma K, Ferreyra G, Ambrogio C, et al. Patient-ventilator interaction and sleep in mechanically ventilated patients: pressure support versus proportional assist ventilation. Critical care medicine. 2007;35(4):1048-1054.],[ANCHOR=View Abstract],[LINK=/content/covidien/websites/medtronic/com/en/covidien/support/clinical-evidence.html?id=352110]),([FOOTNOTE=Xirouchaki N, Kondili E, Klimathianaki M, Georgopoulos D. Is proportional-assist ventilation with load-adjustable gain factors a user-friendly mode? Intensive care medicine. 2009;35(9):1599-1603.],[ANCHOR=View Abstract],[LINK=/content/covidien/websites/medtronic/com/en/covidien/support/clinical-evidence.html?id=719463])

More Information

Approximately 36% of patients admitted to the ICU require mechanical ventilation.([FOOTNOTE=Dasta JF, McLaughlin TP, Mody SH, Piech CT. Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Critical care medicine. 2005;33(6):1266-1271.],[ANCHOR=View Abstract],[LINK=/content/covidien/websites/medtronic/com/en/covidien/support/clinical-evidence.html?id=959739])  Those patients who endure a prolonged time on mechanical ventilation are at-risk for greater resource utilization and length of stay.([FOOTNOTE=Zilberberg MD, Luippold RS, Sulsky S, Shorr AF. Prolonged acute mechanical ventilation, hospital resource utilization, and mortality in the United States. Critical care medicine. 2008;36(3):724-730.],[ANCHOR=View Abstract],[LINK=/content/covidien/websites/medtronic/com/en/covidien/support/clinical-evidence.html?id=1203240])  Therefore a great deal of clinical focus has developed around optimizing the delivery of mechanical ventilation and subsequent weaning. An increasing amount of evidence is revealing the relationship between patient-ventilator asynchrony and adverse outcome in mechanically ventilated patients including increased time on mechanical ventilation and mortality.1,2  Therefore, the identification, prevention and resolution of patient-ventilator asynchrony is increasingly being recognized as being integral to the optimization of quality of care for mechanically ventilated patients.