Asynchrony Type | Possible Resolutions |
---|---|
Ineffective Efforts([FOOTNOTE=de Wit M, Miller KB, Green DA, Ostman HE, Gennings C, Epstein SK. Ineffective triggering predicts increased duration of mechanical ventilation. Critical care medicine. 2009;37(10):2740-2745.],[ANCHOR=View Abstract],[LINK=/content/covidien/websites/medtronic/com/en/covidien/support/clinical-evidence.html?id=720867]),([FOOTNOTE=Thille AW, Rodriguez P, Cabello B, Lellouche F, Brochard L. Patient-ventilator asynchrony during assisted mechanical ventilation. Intensive care medicine. 2006;32(10):1515-1522.],[ANCHOR=View Abstract],[LINK=/content/covidien/websites/medtronic/com/en/covidien/support/clinical-evidence.html?id=805246]),([FOOTNOTE=MacIntyre NR, McConnell R, Cheng KC, Sane A. Patient-ventilator flow dyssynchrony: flow-limited versus pressure-limited breaths. Critical care medicine. 1997;25(10):1671-1677.],[ANCHOR=View Abstract],[LINK=/content/covidien/websites/medtronic/com/en/covidien/support/clinical-evidence.html?id=1203231]),([FOOTNOTE=Tobin M. Principals of mechanical ventilation. 3rd ed. China: McGraw-Hill; 2013],[ANCHOR=],[LINK=]) | More sensitive trigger setting |
Decrease Pressure Support | |
Increase flow cycling criteria | |
Increase PEEP setting | |
Double Triggering1,3,4 | Increase machine Ti |
Increase inspiratory flow | |
Increase tidal volume | |
Decrease flow cycling criteria | |
Auto-Triggering1,3,4 | Decrease trigger sensitivity |
Fix or compensate for system leaks | |
Flow Asynchrony1,3,4 | Adjust flow or flow pattern to match patient demand |
Change to pressure-based mode | |
Assess excessive or depressed drive (if present) | |
Delayed/Prolonged Cycling1,3,4 | Adjust cycling criteria |
Decrease PS Support | |
Assess excessive or depressed drive (if present) |
Asynchrony-related ventilator adjustments place a significant burden on clinicians. For example, Xirouchaki et al. demonstrated that asynchrony was responsible for 42% of all ventilator adjustments related to clinical deterioration in patients undergoing pressure support ventilation.([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/mitg/websites/languagemasters/na/en-us/support/clinical-evidence.html?id=719463])
Furthermore, imprecise adjustments may place patients at increased risk for additional asynchrony and impaired breath delivery.
To lessen this burden, the Puritan Bennett™ 980 ventilator provides a comprehensive solution for the reduction of patient-ventilator asynchrony. Utilization of the PAV+™ software has been demonstrated to reduce asynchrony and improve patient outcome.
Asynchrony Type | Synchrony Tool |
---|---|
Ineffective efforts | PAV+™ |
Auto triggering | Leak Sync |
Double triggering | PAV+™ |
Delayed cycling | PAV+™ |