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Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva

Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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Minerva Anestesiologica 2013 April;79(4):434-44

lingua: Inglese

Patient-ventilator dyssynchrony during assisted invasive mechanical ventilation

Murias G. 1, Villagra A. 2, 3, 4, Blanch L. 2, 3, 4

1 Clínica Bazterrica y Clínica Santa Isabel, Buenos Aires, Argentina;
2 Critical Care Center, Hospital de Sabadell, Corporacio Sanitaria Universitària Parc Tauli, Universitat Autònoma de Barcelona, Sabadell, Spain;
3 CIBER Enfermedades Respiratorias, ISCiii, Madrid, Spain;
4 Fundació Parc Tauli, Corporacio Sanitaria Universitària Parc Tauli, Universitat Autònoma de Barcelona, Sabadell, Spain


Patient-ventilator dyssynchrony is common during mechanical ventilation. Dyssynchrony decreases comfort, prolongs mechanical ventilation and intensive care unit stays, and might lead to worse outcome. Dyssynchrony can occur during the triggering of the ventilator, the inspiration period after triggering, the transition from inspiration to expiration, and the expiratory phase. The most common dyssynchronies are delayed triggering, autotriggering, ineffective inspiratory efforts (which can occur at any point in the respiratory cycle), mismatch between the patient’s and ventilator’s inspiratory times, and double triggering. At present, the detection of dyssynchronies usually depends on healthcare staff observing ventilator waveforms; however, performance is suboptimal and many events go undetected. To date, technological complexity has made it impossible to evaluate patient-ventilator synchrony throughout the course of mechanical ventilation. Studies have shown that a high index of dyssynchrony may increase the duration of mechanical ventilation. Better training, better ventilatory modes, and/or computerized systems that permit better synchronization of patients’ demands and ventilator outputs are necessary to improve patient-ventilator synchrony.

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