Lane Fox Respiratory Unit, Guy's, St Thomas' NHS Foundation Trust, London, UK Division of Asthma, Allergy and Lung Biology, King's College London, London, UK.
Department of Public Health Sciences, King's College London, London, UK Guy's and St Thomas' NHS Foundation Trust and King's College London, National Institute Health Research Biomedical Research Centre, London, UK.
Thorax. 2015 Oct;70(10):946-52. doi: 10.1136/thoraxjnl-2015-206944. Epub 2015 Jul 21.
Patient-ventilator asynchrony (PVA) can adversely affect the successful initiation of non-invasive home mechanical ventilation (HMV). The aim of this observational study was to quantify the prevalence of PVA during initiation of HMV and to determine the relationship between PVA and nocturnal gas exchange.
Type and frequency of PVA were measured by surface parasternal intercostal muscle electromyography, thoracoabdominal plethysmography and mask pressure during initiation of HMV. Severe PVA was defined, as previously, as asynchrony affecting ≥10% of breaths.
28 patients (18 male) were enrolled aged 61±15 years and with a body mass index of 35±9 kg/m(2). Underlying diagnoses were neuromuscular disease with or without chest wall disease (n=6), obesity related chronic respiratory failure (n=12) and COPD (n=10). PVA was observed in all patients with 79% of patients demonstrating severe PVA. Triggering asynchrony was most frequent, observed in 24% (IQR: 11-36%) of breaths, with ineffective efforts accounting for 16% (IQR: 4-24%). PVA types were similar between disease groups, with the exception of auto-triggering, which was higher in patients with COPD (12% (IQR: 6-26%)). There was no correlation observed between PVA and time spent with oxygen saturations ≤90%, mean oxygen saturations or transcutaneous carbon dioxide levels during overnight ventilation.
Severe PVA was identified in the majority of patients, irrespective of pathophysiological disease state. This was not associated with ineffective ventilation as evidenced by gas exchange.
患者-呼吸机不同步（PVA）可对无创性家庭机械通气（HMV）的成功启动产生不利影响。本观察性研究的目的是量化 HMV 启动期间 PVA 的发生率，并确定 PVA 与夜间气体交换之间的关系。
通过表面胸旁肋间肌肌电图、胸廓-腹部体描法和面罩压力来测量 PVA 的类型和频率，在启动 HMV 期间。以前将严重的 PVA 定义为影响≥10%呼吸的不同步。
共纳入 28 名患者（18 名男性），年龄 61±15 岁，体重指数为 35±9kg/m²。基础诊断为伴有或不伴有胸壁疾病的神经肌肉疾病（n=6）、肥胖相关慢性呼吸衰竭（n=12）和 COPD（n=10）。所有患者均观察到 PVA，79%的患者表现为严重 PVA。触发不同步最常见，占 24%（IQR：11-36%）的呼吸，无效努力占 16%（IQR：4-24%）。不同疾病组之间的 PVA 类型相似，但自动触发除外，COPD 患者更高（12%（IQR：6-26%））。在整个夜间通气期间，PVA 与血氧饱和度≤90%、平均血氧饱和度或经皮二氧化碳水平之间没有观察到相关性。
无论病理生理疾病状态如何，大多数患者均存在严重的 PVA。这与无效通气无关，这可以通过气体交换来证明。
