Dres Martin, Rittayamai Nuttapol, Brochard Laurent
aSorbonne Universités, UPMC Univ Paris 06, INSERM, UMRS_1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France bKeenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital cInterdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada dDepartment of Medicine, Division of Respiratory Diseases and Tuberculosis, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Curr Opin Crit Care. 2016 Jun;22(3):246-53. doi: 10.1097/MCC.0000000000000307.
This article describes and discusses the importance of monitoring patient-ventilator asynchrony, and the advantages and limitations of the specific techniques available at the bedside to evaluate it.
Signals provided by esophageal catheters (pressure or electromyogram) are the most reliable and accurate instruments to detect asynchronies. Esophageal signals (providing electrical activity of the diaphragm or/and esophageal pressure) have allowed the recent description of reverse triggering, a new kind of asynchrony, in which mechanical insufflation repeatedly triggers diaphragmatic contractions. However, the use of esophageal catheters is not widespread, and data on the prevalence and consequences of asynchronies are still scarce. The development of software solutions that continuously and automatically record breathing waveforms from the ventilator recording is emerging. Using this technology, recent data support the fact that asynchronies are frequent and may be negatively associated with outcome.
The prevalence and consequences of asynchronies may be largely underestimated because of a frequent lack of monitoring. Dedicated software solutions that continuously and automatically detect asynchronies may allow both clinical research and clinical applications aimed at determining the effects of asynchronies and minimizing their incidence among critically ill patients.
本文描述并讨论了监测患者-呼吸机不同步的重要性，以及床边可用的评估该情况的特定技术的优缺点。
食管导管提供的信号（压力或肌电图）是检测不同步最可靠、最准确的工具。食管信号（提供膈肌电活动或/和食管压力）使得最近对反向触发这一新型不同步现象有了描述，即机械通气反复触发膈肌收缩。然而，食管导管的使用并不广泛，关于不同步发生率及后果的数据仍然很少。能够持续自动记录呼吸机记录的呼吸波形的软件解决方案正在兴起。利用这项技术，最近的数据支持了不同步很常见且可能与预后呈负相关这一事实。
由于经常缺乏监测，不同步的发生率及后果可能被大大低估。能够持续自动检测不同步的专用软件解决方案可能有助于临床研究和临床应用，旨在确定不同步的影响并尽量减少其在重症患者中的发生率。
