Unidad de Cuidados Intensivos - 8B, Hospital Clínico Quirúrgico "Hermanos Ameijeiras", Universidad de Ciencias Médicas de La Habana, La Habana, Cuba.
Unidad de Cuidados Intensivos, Hospital Universitario "Dr. Miguel Enríquez", Universidad de Ciencias Médicas de La Habana, La Habana, Cuba.
Rev Bras Ter Intensiva. 2020 Jun;32(2):284-294. doi: 10.5935/0103-507x.20200045. Epub 2020 Jul 13.
To identify the relationship of patient-ventilator asynchrony with the level of sedation and hemogasometric and clinical results.
This was a prospective study of 122 patients admitted to the intensive care unit who underwent > 24 hours of invasive mechanical ventilation with inspiratory effort. In the first 7 days of ventilation, patient-ventilator asynchrony was evaluated daily for 30 minutes. Severe patient-ventilator asynchrony was defined as an asynchrony index > 10%.
A total of 339,652 respiratory cycles were evaluated in 504 observations. The mean asynchrony index was 37.8% (standard deviation 14.1 - 61.5%). The prevalence of severe patient-ventilator asynchrony was 46.6%. The most frequent patient-ventilator asynchronies were ineffective trigger (13.3%), autotrigger (15.3%), insufficient flow (13.5%), and delayed cycling (13.7%). Severe patient-ventilator asynchrony was related to the level of sedation (ineffective trigger: p = 0.020; insufficient flow: p = 0.016; premature cycling: p = 0.023) and the use of midazolam (p = 0.020). Severe patient-ventilator asynchrony was also associated with hemogasometric changes. The persistence of severe patient-ventilator asynchrony was an independent risk factor for failure of the spontaneous breathing test, ventilation time, ventilator-associated pneumonia, organ dysfunction, mortality in the intensive care unit, and length of stay in the intensive care unit.
Patient-ventilator asynchrony is a frequent disorder in critically ill patients with inspiratory effort. The patient's interaction with the ventilator should be optimized to improve hemogasometric parameters and clinical results. Further studies are required to confirm these results.
确定患者-呼吸机不同步与镇静水平、血气和临床结果的关系。
这是一项对 122 名接受>24 小时有创机械通气并进行吸气努力的重症监护病房患者进行的前瞻性研究。在通气的前 7 天，每天评估 30 分钟的患者-呼吸机不同步情况。严重的患者-呼吸机不同步定义为同步指数>10%。
共评估了 504 次观察中的 339652 个呼吸周期。平均同步指数为 37.8%（标准差 14.1-61.5%）。严重患者-呼吸机不同步的发生率为 46.6%。最常见的患者-呼吸机不同步包括无效触发（13.3%）、自动触发（15.3%）、流量不足（13.5%）和延迟循环（13.7%）。严重的患者-呼吸机不同步与镇静水平有关（无效触发：p=0.020；流量不足：p=0.016；过早循环：p=0.023）和咪达唑仑的使用（p=0.020）。严重的患者-呼吸机不同步也与血气变化有关。严重的患者-呼吸机不同步持续存在是自主呼吸试验失败、通气时间、呼吸机相关性肺炎、器官功能障碍、重症监护病房死亡率和重症监护病房住院时间的独立危险因素。
有吸气努力的重症患者中，患者-呼吸机不同步是一种常见的障碍。应优化患者与呼吸机的相互作用，以改善血气参数和临床结果。需要进一步的研究来证实这些结果。
