Identifying asynchronies: Ineffective effort

Víctor Perez, Jamille Pasco

Abstract

Mechanical ventilation is a common issue in critically ill patients. It is a lifesaving treatment but also can cause some complications.

Patient-ventilator asynchronies are frequent but are often underdiagnosed and they are a serious problem that is associated with worse clinical outcomes.

Asynchrony occurs when there is a mismatch between the ventilator setting and the patient´s demand or breath delivery timing.

There are a variety of asynchronies between the patient’s respiratory efforts and the programed ventilatory setting. Ineffective effort is a kind of asynchrony of the trigger variable. It occurs when the patient’s inspiratory effort fails to trigger a ventilator breath.

Ineffective inspiratory efforts are a great problem in patient-ventilator interaction, and they are the most common type of asynchrony.

Keywords: asynchrony, ventilator, demand, timing, trigger, ineffective effort.

References

1. Murias G, Lucangelo U, Blanch L. Patient-ventilator asynchrony. Curr Opin Crit Care 2016; 22(1):53-59. https://doi.org/10.1097/MCC.0000000000000270 PMid:26627539

2. Dres M, Rittayamai, Brochard L. Monitoring patient-ventilator asynchrony. Curr Opin Crit Care 2016; 22(3):.246-253. https://doi.org/10.1097/MCC.0000000000000307 PMid:27070802

3. de Wit M, Miller KB, Green DA, et al. Ineffective triggering predicts increased duration of mechanical ventilation. Crit Care Med 2009; 37(10): 2740 -2745. https://doi.org/10.1097/00003246-200910000-00010 PMid:19886000

4. Thille AW, Rodriguez P, Cabello B, et al. Patient-ventilator asynchrony during assisted mechanical ventilation. Intensive Care Med 2006; 32(10):1515-1522. https://doi.org/10.1007/s00134-006-0301-8 PMid:16896854

5. Blanch L, Villagra A, Sales B, et al. Asynchronies during mechanical ventilation are associated with mortality. Intensive Care Med 2015; 41(4):633-641. https://doi.org/10.1007/s00134-015-3692-6 PMid:25693449

6. Nilsestuen JO, Hargett KD. Using ventilator graphics to identify patient-ventilator asynchrony. Respir Care 2005; 50(2):202-234. PMID: 15691392

7. Gurevitch MJ, Gelmont D. Importance of trigger sensitivity to ventilator response delay in advanced chronic obstructive pulmonary disease with respiratory failure. Crit Care Med 1989; 17(4):354-359. https://doi.org/10.1097/00003246-198904000-00011 PMid:2639663

8. Ashutosh K, Gilbert R, Auchincloss JHJ, et al. Asynchronous breathing movements in patients with chronic obstructive pulmonary disease. Chest 1975; 67(5):553-557. https://doi.org/10.1378/chest.67.5.553 PMid:1126193

9. Mirabella L, Cinnella G, Costa R, et al. Patient-ventilator asynchronies: clinical implications and practical. Respir Care 2020; 65(11):1751-1766. https://doi.org/10.4187/respcare.07284 PMid:32665426

10. Branson RD, Blakeman TC, Robinson BR. Asynchrony and dyspnea. Respir Care 2013; 58(6):973-986. https://doi.org/10.4187/respcare.02507 PMid:23709195