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Patient-Ventilator Dyssynchrony

  • Hooman Poor

Abstract

For patients receiving mechanical ventilation who are not using their respiratory muscles, all of the work of breathing is done by the ventilator. This scenario often occurs in the setting of deep sedation, paralysis, or significant neurologic dysfunction. However, many patients receiving mechanical ventilation are active participants in the respiratory process and use their respiratory muscles. The ventilator’s role for these patients is to reduce the work of breathing. In order for this collaboration between the patient and the ventilator to occur successfully, a significant amount of synchrony is necessary for breath initiation (trigger), inspiratory flow determination (target), and breath termination (cycle). Dyssynchrony between the patient and the ventilator can result in significant patient discomfort and increased work of breathing. The types of dyssynchrony are characterized as those that occur during the trigger phase, the target phase, and the cycle phase.

Keywords

Ineffective triggering Missed triggering Extra triggering Expiratory flow limitation Auto-triggering Double triggering Neural inspiratory time Premature cycling Reverse triggering Entrainment Delayed cycling 

Suggested Readings

  1. 1.
    Branson R, Blakeman T, Robinson B. Asynchrony and dyspnea. Respir Care. 2013;58:973–89.CrossRefPubMedGoogle Scholar
  2. 2.
    Cairo J. Pilbeam’s mechanical ventilation: physiological and clinical applications. 5th ed. St. Louis: Mosby; 2012.Google Scholar
  3. 3.
    Gentile M. Cycling of the mechanical ventilator breath. Respir Care. 2011;56:52–60.CrossRefPubMedGoogle Scholar
  4. 4.
    Gilstrap D, MacIntyre N. Patient-ventilator interactions. Implications for clinical management. Am J Respir Crit Care Med. 2013;188:1058–68.CrossRefPubMedGoogle Scholar
  5. 5.
    MacIntyre N, Branson R. Mechanical ventilation. 2nd ed. Philadelphia: Saunders; 2009.Google Scholar
  6. 6.
    Nilstestuen J, Hargett K. Using ventilator graphics to identify patient-ventilator asynchrony. Respir Care. 2005;52:202–34.Google Scholar
  7. 7.
    Tobin M, Lodato R. PEEP, auto-PEEP, and waterfalls. Chest. 1989;96:449–51.CrossRefPubMedGoogle Scholar
  8. 8.
    Tobin M. Principles and practice of mechanical ventilation. 3rd ed. Beijing: McGraw-Hill; 2013.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Hooman Poor
    • 1
  1. 1.Mount Sinai – National Jewish Health Respiratory InstituteIcahn School of MedicineNew YorkUSA

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