Automatic Adjustment of the Inspiratory Trigger and Cycling-Off Criteria Improved Patient-Ventilator Asynchrony During Pressure Support Ventilation.

Patient-ventilator asynchrony is common during pressure support ventilation (PSV) because of the constant cycling-off criteria and variation of respiratory system mechanical properties in individual patients. Automatic adjustment of inspiratory triggers and cycling-off criteria based on waveforms might be a useful tool to improve patient-ventilator asynchrony during PSV. Twenty-four patients were enrolled and were ventilated using PSV with different cycling-off criteria of 10% (PS), 30% (PS), 50% (PS), and automatic adjustment PSV (PS). Patient-ventilator interactions were measured. The total asynchrony index (AI) and NeuroSync index were consistently lower in PS when compared with PS, PS, and PS, ( < 0.05). The benefit of PS in reducing the total AI was mainly because of the reduction of the micro-AI but not the macro-AI. PS significantly improved the relative cycling-off error when compared with prefixed controlled PSV ( < 0.05). PS significantly reduced the trigger error and inspiratory effort for the trigger when compared with a prefixed trigger. However, total inspiratory effort, breathing patterns, and respiratory drive were not different among modes. When compared with fixed cycling-off criteria, an automatic adjustment system improved patient-ventilator asynchrony without changes in breathing patterns during PSV. The automatic adjustment system could be a useful tool to titrate more personalized mechanical ventilation.