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. 2017 Dec 20;7(1):122.
doi: 10.1186/s13613-017-0344-8.

Patient-ventilator asynchrony during conventional mechanical ventilation in children

Guillaume Mortamet  1   2   3 , Alexandrine Larouche  1   3 , Laurence Ducharme-Crevier  1   3 , Olivier Fléchelles  4 , Gabrielle Constantin  1   3 , Sandrine Essouri  3   5 , Amélie-Ann Pellerin-Leblanc  6 , Jennifer Beck  7   8   9 , Christer Sinderby  7   9   10 , Philippe Jouvet  1   3 , Guillaume Emeriaud  11   12
Affiliations

Patient-ventilator asynchrony during conventional mechanical ventilation in children

Guillaume Mortamet et al. Ann Intensive Care. .

Abstract

Background: We aimed (1) to describe the characteristics of patient-ventilator asynchrony in a population of critically ill children, (2) to describe the risk factors associated with patient-ventilator asynchrony, and (3) to evaluate the association between patient-ventilator asynchrony and ventilator-free days at day 28.

Methods: In this single-center prospective study, consecutive children admitted to the PICU and mechanically ventilated for at least 24 h were included. Patient-ventilator asynchrony was analyzed by comparing the ventilator pressure curve and the electrical activity of the diaphragm (Edi) signal with (1) a manual analysis and (2) using a standardized fully automated method.

Results: Fifty-two patients (median age 6 months) were included in the analysis. Eighteen patients had a very low ventilatory drive (i.e., peak Edi < 2 µV on average), which prevented the calculation of patient-ventilator asynchrony. Children spent 27% (interquartile 22-39%) of the time in conflict with the ventilator. Cycling-off errors and trigger delays contributed to most of this asynchronous time. The automatic algorithm provided a NeuroSync index of 45%, confirming the high prevalence of asynchrony. No association between the severity of asynchrony and ventilator-free days at day 28 or any other clinical secondary outcomes was observed, but the proportion of children with good synchrony was very low.

Conclusion: Patient-ventilator interaction is poor in children supported by conventional ventilation, with a high frequency of depressed ventilatory drive and a large proportion of time spent in asynchrony. The clinical benefit of strategies to improve patient-ventilator interactions should be evaluated in pediatric critical care.

Keywords: Diaphragm function; Mechanical ventilation; Patient–ventilator asynchrony; Patient–ventilator interaction; Pediatric intensive care unit; Pediatrics.

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Figures

Fig. 1
Fig. 1
Study flowchart (*patients could be excluded for two reasons)
Fig. 2
Fig. 2
Contribution of the different types of asynchrony in the total time spent in conflict with the ventilator
Fig. 3
Fig. 3
Evolution of inspiratory Edi (panel a) and of the time spent in asynchrony (panel b) from inclusion time (time 1) to pre-extubation period (time 2)
Fig. 4
Fig. 4
Relationship between the asynchrony results obtained using the two methods: the automatic NeuroSync index and the percentage of time spent in asynchrony derived from the manual breath-by-breath analysis
See this image and copyright information in PMC

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