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. 2021 Aug 16;9(1):50.
doi: 10.1186/s40560-021-00565-5.

Patient-ventilator asynchrony, impact on clinical outcomes and effectiveness of interventions: a systematic review and meta-analysis

Michihito Kyo  1 , Tatsutoshi Shimatani  2 , Koji Hosokawa  3 , Shunsuke Taito  4   5 , Yuki Kataoka  6   5   7   8 , Shinichiro Ohshimo  2 , Nobuaki Shime  2
Affiliations

Patient-ventilator asynchrony, impact on clinical outcomes and effectiveness of interventions: a systematic review and meta-analysis

Michihito Kyo et al. J Intensive Care. .

Abstract

Background: Patient-ventilator asynchrony (PVA) is a common problem in patients undergoing invasive mechanical ventilation (MV) in the intensive care unit (ICU), and may accelerate lung injury and diaphragm mis-contraction. The impact of PVA on clinical outcomes has not been systematically evaluated. Effective interventions (except for closed-loop ventilation) for reducing PVA are not well established.

Methods: We performed a systematic review and meta-analysis to investigate the impact of PVA on clinical outcomes in patients undergoing MV (Part A) and the effectiveness of interventions for patients undergoing MV except for closed-loop ventilation (Part B). We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, ClinicalTrials.gov, and WHO-ICTRP until August 2020. In Part A, we defined asynchrony index (AI) ≥ 10 or ineffective triggering index (ITI) ≥ 10 as high PVA. We compared patients having high PVA with those having low PVA.

Results: Eight studies in Part A and eight trials in Part B fulfilled the eligibility criteria. In Part A, five studies were related to the AI and three studies were related to the ITI. High PVA may be associated with longer duration of mechanical ventilation (mean difference, 5.16 days; 95% confidence interval [CI], 2.38 to 7.94; n = 8; certainty of evidence [CoE], low), higher ICU mortality (odds ratio [OR], 2.73; 95% CI 1.76 to 4.24; n = 6; CoE, low), and higher hospital mortality (OR, 1.94; 95% CI 1.14 to 3.30; n = 5; CoE, low). In Part B, interventions involving MV mode, tidal volume, and pressure-support level were associated with reduced PVA. Sedation protocol, sedation depth, and sedation with dexmedetomidine rather than propofol were also associated with reduced PVA.

Conclusions: PVA may be associated with longer MV duration, higher ICU mortality, and higher hospital mortality. Physicians may consider monitoring PVA and adjusting ventilator settings and sedatives to reduce PVA. Further studies with adjustment for confounding factors are warranted to determine the impact of PVA on clinical outcomes. Trial registration protocols.io (URL: https://www.protocols.io/view/the-impact-of-patient-ventilator-asynchrony-in-adu-bsqtndwn , 08/27/2020).

Keywords: Asynchrony index; ICU; Ineffective triggering; Mechanical ventilation; Mortality; Patient–ventilator interaction.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) flowchart: results of the search strategy
Fig. 2
Fig. 2
Forest plots for ventilated patients with high patient–ventilator asynchrony (PVA) versus low PVA and clinical outcomes in Part A. A Duration of mechanical ventilation. B ICU mortality. C Hospital mortality. D Incidence of reintubation. E, Incidence of tracheostomy. PVA, patient–ventilator asynchrony; AI, asynchrony index; ITI, ineffective triggering index; SD, standard deviation; CI, confidence interval; IV, inverse variance; M–H, Mantel–Haenszel
Fig. 2
Fig. 2
Forest plots for ventilated patients with high patient–ventilator asynchrony (PVA) versus low PVA and clinical outcomes in Part A. A Duration of mechanical ventilation. B ICU mortality. C Hospital mortality. D Incidence of reintubation. E, Incidence of tracheostomy. PVA, patient–ventilator asynchrony; AI, asynchrony index; ITI, ineffective triggering index; SD, standard deviation; CI, confidence interval; IV, inverse variance; M–H, Mantel–Haenszel
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