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. 2025 Aug 12;53(11):e2261-e2270.
doi: 10.1097/CCM.0000000000006816. Online ahead of print.

The Association Between Patient-Ventilator Asynchrony and Clinical Outcomes in Mechanically Ventilated Patients: A Systematic Review

Melissa J de Bie  1   2 , Petra J Rietveld  2 , Franciska van der Velde-Quist  2 , Nan van Geloven  3 , Jacob W M Snoep  2 , Evert de Jonge  2 , Abraham Schoe  2
Affiliations

The Association Between Patient-Ventilator Asynchrony and Clinical Outcomes in Mechanically Ventilated Patients: A Systematic Review

Melissa J de Bie et al. Crit Care Med. .

Abstract

Objectives: To evaluate associations between patient-ventilator asynchrony (PVA) and clinical outcome measures.

Data sources: For this systematic review, the databases of PubMed, Web of Science, Embase, Cochrane Library, and Emcare were screened until June 20, 2024.

Study selection: The main inclusion criterion was the assessment of the association of PVA with clinical outcome measures (length of ICU stay, mechanical ventilation duration, and mortality).

Data extraction: All forms of PVA subtypes reported in the articles were systematically collected. Furthermore, the method used to identify asynchrony and the clinical outcomes described were recorded from each study.

Data synthesis: A total of 19 studies were included with a total of 2672 patients. The results of the meta-analysis show that overall PVA and ineffective triggering and double triggering are associated with a longer duration of mechanical ventilation (mean difference, 3.29 d; 95% CI, 0.13-6.44 d), and with a longer ICU length of stay (mean difference, 3.65 d; 95% CI, 1.20-6.11 d). No association was found between PVA and mortality. In addition, reverse triggering appears to have a potential positive association with outcome.

Conclusions: PVA and specifically ineffective triggering and double triggering, are associated with a longer duration of mechanical ventilation and longer ICU length of stay.

Keywords: artificial respiration; critical care; patient outcome assessment; patient-ventilator asynchrony; systematic review (publication type).

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Conflict of interest statement

Drs. de Bie’s, van der Velde-Quist’s, and Schoe’s institution received funding from Hamilton Medical AG. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram.
Figure 2.
Figure 2.
Forest plot showing differences in mechanical ventilation duration by asynchrony index (AI) greater than 10%. MD = mean difference (d).
Figure 3.
Figure 3.
Forest plot showing differences in length of stay on the ICU by asynchrony index (AI) greater than 10%. MD = mean difference (d).
See this image and copyright information in PMC

References

    1. Holanda MA, Vasconcelos RDS, Ferreira JC, et al. : Patient-ventilator asynchrony. J Bras Pneumol. 2018; 44:321–333 - PMC - PubMed
    1. Zhou Y, Holets SR, Li M, et al. : Etiology, incidence, and outcomes of patient-ventilator asynchrony in critically-ill patients undergoing invasive mechanical ventilation. Sci Rep. 2021; 11:12390. - PMC - PubMed
    1. Epstein SK: How often does patient-ventilator asynchrony occur and what are the consequences? Respir Care. 2011; 56:25–38 - PubMed
    1. Garofalo E, Bruni A, Pelaia C, et al. : Recognizing, quantifying and managing patient-ventilator asynchrony in invasive and noninvasive ventilation. Expert Rev Respir Med. 2018; 12:557–567 - PubMed
    1. Bulleri E, Fusi C, Bambi S, et al. : Patient-ventilator asynchronies: Types, outcomes and nursing detection skills. Acta Biomed. 2018; 89:6–18 - PMC - PubMed

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