Etiology, incidence, and outcomes of patient–ventilator asynchrony in critically-ill patients undergoing invasive mechanical ventilation

Abstract Patient–ventilator asynchrony (PVA) is commonly encountered during mechanical ventilation of critically ill patients. Estimates of PVA incidence vary widely. Type, risk factors, and consequences of PVA remain unclear. We aimed to measure the incidence and identify types of PVA, characterize...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Yongfang Zhou, Steven R. Holets, Man Li, Gustavo A. Cortes-Puentes, Todd J. Meyer, Andrew C. Hanson, Phillip J. Schulte, Richard A. Oeckler
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/d0fadfa2485e472aadf2d008b3dc36d8
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:d0fadfa2485e472aadf2d008b3dc36d8
record_format	dspace
spelling	oai:doaj.org-article:d0fadfa2485e472aadf2d008b3dc36d82021-12-02T17:30:53ZEtiology, incidence, and outcomes of patient–ventilator asynchrony in critically-ill patients undergoing invasive mechanical ventilation10.1038/s41598-021-90013-z2045-2322https://doaj.org/article/d0fadfa2485e472aadf2d008b3dc36d82021-06-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-90013-zhttps://doaj.org/toc/2045-2322Abstract Patient–ventilator asynchrony (PVA) is commonly encountered during mechanical ventilation of critically ill patients. Estimates of PVA incidence vary widely. Type, risk factors, and consequences of PVA remain unclear. We aimed to measure the incidence and identify types of PVA, characterize risk factors for development, and explore the relationship between PVA and outcome among critically ill, mechanically ventilated adult patients admitted to medical, surgical, and medical-surgical intensive care units in a large academic institution staffed with varying provider training background. A single center, retrospective cohort study of all adult critically ill patients undergoing invasive mechanical ventilation for ≥ 12 h. A total of 676 patients who underwent 696 episodes of mechanical ventilation were included. Overall PVA occurred in 170 (24%) episodes. Double triggering 92(13%) was most common, followed by flow starvation 73(10%). A history of smoking, and pneumonia, sepsis, or ARDS were risk factors for overall PVA and double triggering (all P < 0.05). Compared with volume targeted ventilation, pressure targeted ventilation decreased the occurrence of events (all P < 0.01). During volume controlled synchronized intermittent mandatory ventilation and pressure targeted ventilation, ventilator settings were associated with the incidence of overall PVA. The number of overall PVA, as well as double triggering and flow starvation specifically, were associated with worse outcomes and fewer hospital-free days (all P < 0.01). Double triggering and flow starvation are the most common PVA among critically ill, mechanically ventilated patients. Overall incidence as well as double triggering and flow starvation PVA specifically, portend worse outcome.Yongfang ZhouSteven R. HoletsMan LiGustavo A. Cortes-PuentesTodd J. MeyerAndrew C. HansonPhillip J. SchulteRichard A. OecklerNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Yongfang Zhou Steven R. Holets Man Li Gustavo A. Cortes-Puentes Todd J. Meyer Andrew C. Hanson Phillip J. Schulte Richard A. Oeckler Etiology, incidence, and outcomes of patient–ventilator asynchrony in critically-ill patients undergoing invasive mechanical ventilation
description	Abstract Patient–ventilator asynchrony (PVA) is commonly encountered during mechanical ventilation of critically ill patients. Estimates of PVA incidence vary widely. Type, risk factors, and consequences of PVA remain unclear. We aimed to measure the incidence and identify types of PVA, characterize risk factors for development, and explore the relationship between PVA and outcome among critically ill, mechanically ventilated adult patients admitted to medical, surgical, and medical-surgical intensive care units in a large academic institution staffed with varying provider training background. A single center, retrospective cohort study of all adult critically ill patients undergoing invasive mechanical ventilation for ≥ 12 h. A total of 676 patients who underwent 696 episodes of mechanical ventilation were included. Overall PVA occurred in 170 (24%) episodes. Double triggering 92(13%) was most common, followed by flow starvation 73(10%). A history of smoking, and pneumonia, sepsis, or ARDS were risk factors for overall PVA and double triggering (all P < 0.05). Compared with volume targeted ventilation, pressure targeted ventilation decreased the occurrence of events (all P < 0.01). During volume controlled synchronized intermittent mandatory ventilation and pressure targeted ventilation, ventilator settings were associated with the incidence of overall PVA. The number of overall PVA, as well as double triggering and flow starvation specifically, were associated with worse outcomes and fewer hospital-free days (all P < 0.01). Double triggering and flow starvation are the most common PVA among critically ill, mechanically ventilated patients. Overall incidence as well as double triggering and flow starvation PVA specifically, portend worse outcome.
format	article
author	Yongfang Zhou Steven R. Holets Man Li Gustavo A. Cortes-Puentes Todd J. Meyer Andrew C. Hanson Phillip J. Schulte Richard A. Oeckler
author_facet	Yongfang Zhou Steven R. Holets Man Li Gustavo A. Cortes-Puentes Todd J. Meyer Andrew C. Hanson Phillip J. Schulte Richard A. Oeckler
author_sort	Yongfang Zhou
title	Etiology, incidence, and outcomes of patient–ventilator asynchrony in critically-ill patients undergoing invasive mechanical ventilation
title_short	Etiology, incidence, and outcomes of patient–ventilator asynchrony in critically-ill patients undergoing invasive mechanical ventilation
title_full	Etiology, incidence, and outcomes of patient–ventilator asynchrony in critically-ill patients undergoing invasive mechanical ventilation
title_fullStr	Etiology, incidence, and outcomes of patient–ventilator asynchrony in critically-ill patients undergoing invasive mechanical ventilation
title_full_unstemmed	Etiology, incidence, and outcomes of patient–ventilator asynchrony in critically-ill patients undergoing invasive mechanical ventilation
title_sort	etiology, incidence, and outcomes of patient–ventilator asynchrony in critically-ill patients undergoing invasive mechanical ventilation
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/d0fadfa2485e472aadf2d008b3dc36d8
work_keys_str_mv	AT yongfangzhou etiologyincidenceandoutcomesofpatientventilatorasynchronyincriticallyillpatientsundergoinginvasivemechanicalventilation AT stevenrholets etiologyincidenceandoutcomesofpatientventilatorasynchronyincriticallyillpatientsundergoinginvasivemechanicalventilation AT manli etiologyincidenceandoutcomesofpatientventilatorasynchronyincriticallyillpatientsundergoinginvasivemechanicalventilation AT gustavoacortespuentes etiologyincidenceandoutcomesofpatientventilatorasynchronyincriticallyillpatientsundergoinginvasivemechanicalventilation AT toddjmeyer etiologyincidenceandoutcomesofpatientventilatorasynchronyincriticallyillpatientsundergoinginvasivemechanicalventilation AT andrewchanson etiologyincidenceandoutcomesofpatientventilatorasynchronyincriticallyillpatientsundergoinginvasivemechanicalventilation AT phillipjschulte etiologyincidenceandoutcomesofpatientventilatorasynchronyincriticallyillpatientsundergoinginvasivemechanicalventilation AT richardaoeckler etiologyincidenceandoutcomesofpatientventilatorasynchronyincriticallyillpatientsundergoinginvasivemechanicalventilation
_version_	1718380756005289984

Etiology, incidence, and outcomes of patient–ventilator asynchrony in critically-ill patients undergoing invasive mechanical ventilation

Ejemplares similares