Automatic Adjustment of the Inspiratory Trigger and Cycling-Off Criteria Improved Patient-Ventilator Asynchrony During Pressure Support Ventilation

Background: Patient-ventilator asynchrony is common during pressure support ventilation (PSV) because of the constant cycling-off criteria and variation of respiratory system mechanical properties in individual patients. Automatic adjustment of inspiratory triggers and cycling-off criteria based on...

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Autores principales:	Ling Liu, Yue Yu, Xiaoting Xu, Qin Sun, Haibo Qiu, Davide Chiumello, Yi Yang
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	automatic adjustment system pressure support ventilation patient-ventilator asynchrony cycling-off trigger Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/e400f54f08df47dca3cbfd668a49f3f0
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spelling	oai:doaj.org-article:e400f54f08df47dca3cbfd668a49f3f02021-11-12T05:09:00ZAutomatic Adjustment of the Inspiratory Trigger and Cycling-Off Criteria Improved Patient-Ventilator Asynchrony During Pressure Support Ventilation2296-858X10.3389/fmed.2021.752508https://doaj.org/article/e400f54f08df47dca3cbfd668a49f3f02021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fmed.2021.752508/fullhttps://doaj.org/toc/2296-858XBackground: Patient-ventilator asynchrony is common during pressure support ventilation (PSV) because of the constant cycling-off criteria and variation of respiratory system mechanical properties in individual patients. Automatic adjustment of inspiratory triggers and cycling-off criteria based on waveforms might be a useful tool to improve patient-ventilator asynchrony during PSV.Method: Twenty-four patients were enrolled and were ventilated using PSV with different cycling-off criteria of 10% (PS10), 30% (PS30), 50% (PS50), and automatic adjustment PSV (PSAUTO). Patient-ventilator interactions were measured.Results: The total asynchrony index (AI) and NeuroSync index were consistently lower in PSAUTO when compared with PS10, PS30, and PS50, (P < 0.05). The benefit of PSAUTO in reducing the total AI was mainly because of the reduction of the micro-AI but not the macro-AI. PSAUTO significantly improved the relative cycling-off error when compared with prefixed controlled PSV (P < 0.05). PSAUTO significantly reduced the trigger error and inspiratory effort for the trigger when compared with a prefixed trigger. However, total inspiratory effort, breathing patterns, and respiratory drive were not different among modes.Conclusions: When compared with fixed cycling-off criteria, an automatic adjustment system improved patient-ventilator asynchrony without changes in breathing patterns during PSV. The automatic adjustment system could be a useful tool to titrate more personalized mechanical ventilation.Ling LiuYue YuXiaoting XuQin SunHaibo QiuDavide ChiumelloDavide ChiumelloDavide ChiumelloYi YangFrontiers Media S.A.articleautomatic adjustment systempressure support ventilationpatient-ventilator asynchronycycling-offtriggerMedicine (General)R5-920ENFrontiers in Medicine, Vol 8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	automatic adjustment system pressure support ventilation patient-ventilator asynchrony cycling-off trigger Medicine (General) R5-920
spellingShingle	automatic adjustment system pressure support ventilation patient-ventilator asynchrony cycling-off trigger Medicine (General) R5-920 Ling Liu Yue Yu Xiaoting Xu Qin Sun Haibo Qiu Davide Chiumello Davide Chiumello Davide Chiumello Yi Yang Automatic Adjustment of the Inspiratory Trigger and Cycling-Off Criteria Improved Patient-Ventilator Asynchrony During Pressure Support Ventilation
description	Background: Patient-ventilator asynchrony is common during pressure support ventilation (PSV) because of the constant cycling-off criteria and variation of respiratory system mechanical properties in individual patients. Automatic adjustment of inspiratory triggers and cycling-off criteria based on waveforms might be a useful tool to improve patient-ventilator asynchrony during PSV.Method: Twenty-four patients were enrolled and were ventilated using PSV with different cycling-off criteria of 10% (PS10), 30% (PS30), 50% (PS50), and automatic adjustment PSV (PSAUTO). Patient-ventilator interactions were measured.Results: The total asynchrony index (AI) and NeuroSync index were consistently lower in PSAUTO when compared with PS10, PS30, and PS50, (P < 0.05). The benefit of PSAUTO in reducing the total AI was mainly because of the reduction of the micro-AI but not the macro-AI. PSAUTO significantly improved the relative cycling-off error when compared with prefixed controlled PSV (P < 0.05). PSAUTO significantly reduced the trigger error and inspiratory effort for the trigger when compared with a prefixed trigger. However, total inspiratory effort, breathing patterns, and respiratory drive were not different among modes.Conclusions: When compared with fixed cycling-off criteria, an automatic adjustment system improved patient-ventilator asynchrony without changes in breathing patterns during PSV. The automatic adjustment system could be a useful tool to titrate more personalized mechanical ventilation.
format	article
author	Ling Liu Yue Yu Xiaoting Xu Qin Sun Haibo Qiu Davide Chiumello Davide Chiumello Davide Chiumello Yi Yang
author_facet	Ling Liu Yue Yu Xiaoting Xu Qin Sun Haibo Qiu Davide Chiumello Davide Chiumello Davide Chiumello Yi Yang
author_sort	Ling Liu
title	Automatic Adjustment of the Inspiratory Trigger and Cycling-Off Criteria Improved Patient-Ventilator Asynchrony During Pressure Support Ventilation
title_short	Automatic Adjustment of the Inspiratory Trigger and Cycling-Off Criteria Improved Patient-Ventilator Asynchrony During Pressure Support Ventilation
title_full	Automatic Adjustment of the Inspiratory Trigger and Cycling-Off Criteria Improved Patient-Ventilator Asynchrony During Pressure Support Ventilation
title_fullStr	Automatic Adjustment of the Inspiratory Trigger and Cycling-Off Criteria Improved Patient-Ventilator Asynchrony During Pressure Support Ventilation
title_full_unstemmed	Automatic Adjustment of the Inspiratory Trigger and Cycling-Off Criteria Improved Patient-Ventilator Asynchrony During Pressure Support Ventilation
title_sort	automatic adjustment of the inspiratory trigger and cycling-off criteria improved patient-ventilator asynchrony during pressure support ventilation
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/e400f54f08df47dca3cbfd668a49f3f0
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Automatic Adjustment of the Inspiratory Trigger and Cycling-Off Criteria Improved Patient-Ventilator Asynchrony During Pressure Support Ventilation

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