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01.04.2015 | Original

Asynchronies during mechanical ventilation are associated with mortality

verfasst von: Lluís Blanch, Ana Villagra, Bernat Sales, Jaume Montanya, Umberto Lucangelo, Manel Luján, Oscar García-Esquirol, Encarna Chacón, Anna Estruga, Joan C. Oliva, Alberto Hernández-Abadia, Guillermo M. Albaiceta, Enrique Fernández-Mondejar, Rafael Fernández, Josefina Lopez-Aguilar, Jesús Villar, Gastón Murias, Robert M. Kacmarek

Erschienen in: Intensive Care Medicine | Ausgabe 4/2015

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Abstract

Purpose

This study aimed to assess the prevalence and time course of asynchronies during mechanical ventilation (MV).

Methods

Prospective, noninterventional observational study of 50 patients admitted to intensive care unit (ICU) beds equipped with Better Care™ software throughout MV. The software distinguished ventilatory modes and detected ineffective inspiratory efforts during expiration (IEE), double-triggering, aborted inspirations, and short and prolonged cycling to compute the asynchrony index (AI) for each hour. We analyzed 7,027 h of MV comprising 8,731,981 breaths.

Results

Asynchronies were detected in all patients and in all ventilator modes. The median AI was 3.41 % [IQR 1.95–5.77]; the most common asynchrony overall and in each mode was IEE [2.38 % (IQR 1.36–3.61)]. Asynchronies were less frequent from 12 pm to 6 am [1.69 % (IQR 0.47–4.78)]. In the hours where more than 90 % of breaths were machine-triggered, the median AI decreased, but asynchronies were still present. When we compared patients with AI > 10 vs AI ≤ 10 %, we found similar reintubation and tracheostomy rates but higher ICU and hospital mortality and a trend toward longer duration of MV in patients with an AI above the cutoff.

Conclusions

Asynchronies are common throughout MV, occurring in all MV modes, and more frequently during the daytime. Further studies should determine whether asynchronies are a marker for or a cause of mortality.

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Titel: Asynchronies during mechanical ventilation are associated with mortality
verfasst von: Lluís Blanch
Ana Villagra
Bernat Sales
Jaume Montanya
Umberto Lucangelo
Manel Luján
Oscar García-Esquirol
Encarna Chacón
Anna Estruga
Joan C. Oliva
Alberto Hernández-Abadia
Guillermo M. Albaiceta
Enrique Fernández-Mondejar
Rafael Fernández
Josefina Lopez-Aguilar
Jesús Villar
Gastón Murias
Robert M. Kacmarek
Publikationsdatum: 01.04.2015
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 4/2015
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-015-3692-6

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