Patient-ventilator asynchronies during mechanical ventilation: current knowledge and research priorities
| العنوان: | Patient-ventilator asynchronies during mechanical ventilation: current knowledge and research priorities |
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| المؤلفون: | A. Ochagavía, Sol Fernandez-Gonzalo, Jaume Montanya, Candelaria de Haro, Josefina López-Aguilar, Rudys Magrans, Guillem Navarra-Ventura, Lluis Blanch |
| المساهمون: | de Haro, Candelaria, Ochagavia, Ana, López-Aguilar, Josefina, Fernandez-Gonzalo, Sol, Navarra-Ventura, Guillem, Magrans, Rudy, Montanyà, Jaume, Blanch, Lluí, Lucangelo, Umberto |
| المصدر: | Intensive Care Medicine Experimental Intensive Care Medicine Experimental, Vol 7, Iss S1, Pp 1-14 (2019) |
| بيانات النشر: | Springer International Publishing, 2019. |
| سنة النشر: | 2019 |
| مصطلحات موضوعية: | medicine.medical_specialty, Cognitive, medicine.medical_treatment, Asynchronies, Review, Lung injury, Critical Care and Intensive Care Medicine, Affect (psychology), Big data, Critically ill, Heart lung interaction, ICU, Mechanical ventilation, Outcome, Patient-ventilator interaction, Psychological disorders, 03 medical and health sciences, 0302 clinical medicine, Afterload, medicine, Intensive care medicine, Asynchronie, business.industry, lcsh:Medical emergencies. Critical care. Intensive care. First aid, food and beverages, 030208 emergency & critical care medicine, Cognition, lcsh:RC86-88.9, Preload, 030228 respiratory system, Breathing, Anxiety, medicine.symptom, business |
| الوصف: | Background Mechanical ventilation is common in critically ill patients. This life-saving treatment can cause complications and is also associated with long-term sequelae. Patient-ventilator asynchronies are frequent but underdiagnosed, and they have been associated with worse outcomes. Main body Asynchronies occur when ventilator assistance does not match the patient’s demand. Ventilatory overassistance or underassistance translates to different types of asynchronies with different effects on patients. Underassistance can result in an excessive load on respiratory muscles, air hunger, or lung injury due to excessive tidal volumes. Overassistance can result in lower patient inspiratory drive and can lead to reverse triggering, which can also worsen lung injury. Identifying the type of asynchrony and its causes is crucial for effective treatment. Mechanical ventilation and asynchronies can affect hemodynamics. An increase in intrathoracic pressure during ventilation modifies ventricular preload and afterload of ventricles, thereby affecting cardiac output and hemodynamic status. Ineffective efforts can decrease intrathoracic pressure, but double cycling can increase it. Thus, asynchronies can lower the predictive accuracy of some hemodynamic parameters of fluid responsiveness. New research is also exploring the psychological effects of asynchronies. Anxiety and depression are common in survivors of critical illness long after discharge. Patients on mechanical ventilation feel anxiety, fear, agony, and insecurity, which can worsen in the presence of asynchronies. Asynchronies have been associated with worse overall prognosis, but the direct causal relation between poor patient-ventilator interaction and worse outcomes has yet to be clearly demonstrated. Critical care patients generate huge volumes of data that are vastly underexploited. New monitoring systems can analyze waveforms together with other inputs, helping us to detect, analyze, and even predict asynchronies. Big data approaches promise to help us understand asynchronies better and improve their diagnosis and management. Conclusions Although our understanding of asynchronies has increased in recent years, many questions remain to be answered. Evolving concepts in asynchronies, lung crosstalk with other organs, and the difficulties of data management make more efforts necessary in this field. |
| وصف الملف: | application/pdf; ELETTRONICO |
| اللغة: | English |
| تدمد: | 2197-425X |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::78d30733e420ea26a282b33b4faf82a9Test http://europepmc.org/articles/PMC6658621Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....78d30733e420ea26a282b33b4faf82a9 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 2197425X |
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