RT Journal Article
SR Electronic
T1 Risk factors and prognostic impact of patient-ventilator asynchrony in mechanically ventilated patients. A prospective study
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP OA4473
DO 10.1183/13993003.congress-2015.OA4473
VO 46
IS suppl 59
A1 Camille Rolland-Debord
A1 Côme Bureau
A1 Marc Clavel
A1 Sebastien Perbet
A1 Nicolas Terzi
A1 Achille Kouatchet
A1 Thomas Similowski
A1 Alexandre Demoule
YR 2015
UL http://erj.ersjournals.com/content/46/suppl_59/OA4473.abstract
AB Rational: Patient-ventilator asynchrony (PVA) is a mismatch between patient and ventilator times during mechanical ventilation (MV). The few studies that have investigated their impact have suggested that high prevalence of asynchronies is associated with prolonged duration of MV.Study aims: to quantify prevalence of PVA by electromyographic activity of the diaphragm (Edi), identify risk factors for PVA, describe their consequences on the outcome.Methods: Ancillary study of a randomized controlled trial comparing neurally ventilator adjusted assist to pressure support ventilation in 127 patients. Asynchronies were quantified at H12, 24, 36 and 48 on recordings of flow, airway pressure and Edi. Asynchrony index (AI) was defined as number of asynchrony events/total respiratory rate x100. Severe asynchrony was defined as an AI >20%.Results: Median AI was 24 (0-69). Prolonged and short cycles were the main asynchronies (respectively 37% and 31% of asynchronies) followed by double-triggering (21%). No significant difference was observed in term of age, SAPS II, gender, dyspnea, comfort scale, ATICE between patients with an AI >20% and those with an AI <20%. Length of stay was significantly lower in patients with an AI <20% as compared to those with a high AI at H12 (31.2 ± 11.0 vs 36.8 ± 16.8, p= 0.047). So was extubation delay (12.7 ± 8.1 vs 16,4 ± 11.3; p = 0.04). D28 mortality was similar in the two groups.Conclusion: Based on Edi recording, prevalence of PVA is high. Among all factors, none was associated with an increased PVA. Increased patient-ventilator asynchrony at H12 was associated with prolonged duration of mechanical ventilation and length of stay.