Division of Respiratory Diseases and Tuberculosis, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
BMC Pulm Med. 2024 May 1;24(1):212. doi: 10.1186/s12890-024-03039-0.
Patient-ventilator asynchrony commonly occurs during pressure support ventilation (PSV). IntelliSync + software (Hamilton Medical AG, Bonaduz, Switzerland) is a new ventilation technology that continuously analyzes ventilator waveforms to detect the beginning and end of patient inspiration in real time. This study aimed to evaluate the physiological effect of IntelliSync + software on inspiratory trigger delay time, delta airway (P) and esophageal (P) pressure drop during the trigger phase, airway occlusion pressure at 0.1 s (P), and hemodynamic variables.
A randomized crossover physiologic study was conducted in 14 mechanically ventilated patients under PSV. Patients were randomly assigned to receive conventional flow trigger and cycling, inspiratory trigger synchronization (I-sync), cycle synchronization (C-sync), and inspiratory trigger and cycle synchronization (I/C-sync) for 15 min at each step. Other ventilator settings were kept constant. P, P, airflow, P, respiratory rate, SpO, and hemodynamic variables were recorded. The primary outcome was inspiratory trigger and cycle delay time between each intervention. Secondary outcomes were delta P and P drop during the trigger phase, P, SpO, and hemodynamic variables.
The time to initiate the trigger was significantly shorter with I-sync compared to baseline (208.9±91.7 vs. 301.4±131.7 msec; P = 0.002) and I/C-sync compared to baseline (222.8±94.0 vs. 301.4±131.7 msec; P = 0.005). The I/C-sync group had significantly lower delta P and P drop during the trigger phase compared to C-sync group (-0.7±0.4 vs. -1.2±0.8 cmHO; P = 0.028 and - 1.8±2.2 vs. -2.8±3.2 cmHO; P = 0.011, respectively). No statistically significant differences were found in cycle delay time, P and other physiological variables between the groups.
IntelliSync + software reduced inspiratory trigger delay time compared to the conventional flow trigger system during PSV mode. However, no significant improvements in cycle delay time and other physiological variables were observed with IntelliSync + software.
This study was registered in the Thai Clinical Trial Registry (TCTR20200528003; date of registration 28/05/2020).
在压力支持通气（PSV）过程中，常发生患者-呼吸机不同步。IntelliSync + 软件（Hamilton Medical AG，Bonaduz，瑞士）是一种新的通气技术，它实时连续分析呼吸机波形，以检测患者吸气的开始和结束。本研究旨在评估 IntelliSync + 软件对吸气触发延迟时间、触发相 delta 气道（P）和食管（P）压力下降、0.1 秒时气道阻断压（P）和血流动力学变量的生理影响。
在 14 例接受 PSV 的机械通气患者中进行了一项随机交叉生理研究。患者随机分为接受常规流量触发和循环、吸气触发同步（I-sync）、循环同步（C-sync）和吸气触发和循环同步（I/C-sync），每个步骤持续 15 分钟。保持其他呼吸机设置不变。记录 P、P、气流、P、呼吸频率、SpO 和血流动力学变量。主要结局是每个干预措施之间的吸气触发和循环延迟时间。次要结局是触发相 delta P 和 P 下降、P、SpO 和血流动力学变量。
与基线相比，I-sync 触发的起始时间明显缩短（208.9±91.7 与 301.4±131.7 msec；P=0.002），与 I/C-sync 相比也明显缩短（222.8±94.0 与 301.4±131.7 msec；P=0.005）。I/C-sync 组与 C-sync 组相比，触发相 delta P 和 P 下降幅度明显降低（-0.7±0.4 与-1.2±0.8 cmHO；P=0.028 和-1.8±2.2 与-2.8±3.2 cmHO；P=0.011）。组间在循环延迟时间、P 和其他生理变量方面无统计学差异。
与 PSV 模式下的常规流量触发系统相比，IntelliSync + 软件缩短了吸气触发延迟时间。然而，IntelliSync + 软件并没有显著改善循环延迟时间和其他生理变量。
本研究在泰国临床试验注册中心（TCTR20200528003；注册日期 2020 年 5 月 28 日）注册。
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