Ventilator dyssynchrony – Detection, pathophysiology, and clinical relevance: A Narrative review
| العنوان: | Ventilator dyssynchrony – Detection, pathophysiology, and clinical relevance: A Narrative review |
|---|---|
| المؤلفون: | Bradford J. Smith, Peter D. Sottile, David J. Albers, Marc Moss |
| المصدر: | Annals of Thoracic Medicine, Vol 15, Iss 4, Pp 190-198 (2020) Annals of Thoracic Medicine |
| بيانات النشر: | Medknow, 2020. |
| سنة النشر: | 2020 |
| مصطلحات موضوعية: | Pulmonary and Respiratory Medicine, lcsh:Diseases of the circulatory (Cardiovascular) system, medicine.medical_specialty, Review Article, Acute respiratory distress, Lung injury, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine, Clinical significance, 030212 general & internal medicine, lcsh:RC705-779, Receiver operating characteristic, business.industry, ventilator-induced lung injury, lcsh:Diseases of the respiratory system, acute respiratory distress syndrome, Mechanical breath, Confidence interval, Pathophysiology, ventilator dyssynchrony, 030228 respiratory system, lcsh:RC666-701, patient self-inflicted lung injury, Cardiology, Surgery, Narrative review, Cardiology and Cardiovascular Medicine, business |
| الوصف: | Mortality associated with the acute respiratory distress syndrome remains unacceptably high due in part to ventilator-induced lung injury (VILI). Ventilator dyssynchrony is defined as the inappropriate timing and delivery of a mechanical breath in response to patient effort and may cause VILI. Such deleterious patient–ventilator interactions have recently been termed patient self-inflicted lung injury. This narrative review outlines the detection and frequency of several different types of ventilator dyssynchrony, delineates the different mechanisms by which ventilator dyssynchrony may propagate VILI, and reviews the potential clinical impact of ventilator dyssynchrony. Until recently, identifying ventilator dyssynchrony required the manual interpretation of ventilator pressure and flow waveforms. However, computerized interpretation of ventilator waive forms can detect ventilator dyssynchrony with an area under the receiver operating curve of >0.80. Using such algorithms, ventilator dyssynchrony occurs in 3%–34% of all breaths, depending on the patient population. Moreover, two types of ventilator dyssynchrony, double-triggered and flow-limited breaths, are associated with the more frequent delivery of large tidal volumes >10 mL/kg when compared with synchronous breaths (54% [95% confidence interval (CI), 47%–61%] and 11% [95% CI, 7%–15%]) compared with 0.9% (95% CI, 0.0%–1.9%), suggesting a role in propagating VILI. Finally, a recent study associated frequent dyssynchrony-defined as >10% of all breaths-with an increase in hospital mortality (67 vs. 23%, P = 0.04). However, the clinical significance of ventilator dyssynchrony remains an area of active investigation and more research is needed to guide optimal ventilator dyssynchrony management. |
| تدمد: | 1817-1737 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::0f64d46c896d70c244710359cfde2660Test https://doi.org/10.4103/atm.atm_63_20Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....0f64d46c896d70c244710359cfde2660 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 18171737 |
|---|