Newly Published
Critical Care Medicine  |   September 2017
Prevalence and Prognosis Impact of Patient–Ventilator Asynchrony in Early Phase of Weaning According to Two Detection Methods
Author Notes
  • From the Intensive Care Unit and Respiratory Division (Département “R3S”), Groupe Hospitalier Pitié-Salpêtrière Charles Foix, AP-HP, 75013, Paris, France (C.R-D., C.B., T.P., T.S., A.D.) and Biostatistics, Public Health and Medical Information Department (L.B.), Assistance Publique–Hoôpitaux de Paris, Groupe Hospitalier Pitieé-Salpeêtrieère Charles Foix, Paris, France; INSERM and UPMC, University Paris 6-Pierre et Marie Curie, UMR_S 1158, “Neurophysiologie Respiratoire Expérimentale et Clinique”, Paris, France (C.R.-D., C.B., T.P., T.S., A.D.), Sorbonne Universités, University Paris 6-Pierre et Marie Curie, Paris, France (L.B.); Intensive Care Unit, CHU Limoges, 87042 Limoges Cedex, France (M.C.); Intensive Care Unit, Department of Anesthesiology, Critical Care and Perioperative Medicine, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France (S.P.); R2D2 EA-7281, Université d’Auvergne, Clermont-Ferrand, France (S.P.); CHU de Caen, Department of Intensive Care, Caen, France (N.T.); Medical ICU, Angers University Hospital, Angers, France (A.K.).
  • Submitted for publication November 3, 2016. Accepted for publication July 11, 2017.
    Submitted for publication November 3, 2016. Accepted for publication July 11, 2017.×
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Research Support: This study is an investigator-initiated trial that received financial support from Maquet (Orléans, France).
    Research Support: This study is an investigator-initiated trial that received financial support from Maquet (Orléans, France).×
  • Competing Interests: Dr. Demoule has signed research contracts with Covidien (Dublin, Ireland), Maquet (Orléans, France), and Philips (Amsterdam, The Netherlands); he has also received personal fees from Covidien, Maquet, Resmed (San Diego, California), Fisher and Paykel (Auckland, New Zealand), and MSD (Kenilworth, New Jersey). Dr. Similowski belongs to the board of a research association that has received, over the past 10 yr, unrestricted research grants from Maquet, Hamilton (Bonaduz, Switzerland), Covidien, and Philips; he is the head of a research unit (UMRS 1158) that has signed research contracts with Air Liquide Medical Systems (Anthony, France); he declares no personal conflict of interest with mechanical ventilation firms; he has received personal fees from Lung-pacer (diaphragm pacing in the intensive care unit; Burnaby, Canada); he is listed as inventor or coinventor on several patents, granted or pending, describing a brain–ventilator interface. The other authors declare no competing interests.
    Competing Interests: Dr. Demoule has signed research contracts with Covidien (Dublin, Ireland), Maquet (Orléans, France), and Philips (Amsterdam, The Netherlands); he has also received personal fees from Covidien, Maquet, Resmed (San Diego, California), Fisher and Paykel (Auckland, New Zealand), and MSD (Kenilworth, New Jersey). Dr. Similowski belongs to the board of a research association that has received, over the past 10 yr, unrestricted research grants from Maquet, Hamilton (Bonaduz, Switzerland), Covidien, and Philips; he is the head of a research unit (UMRS 1158) that has signed research contracts with Air Liquide Medical Systems (Anthony, France); he declares no personal conflict of interest with mechanical ventilation firms; he has received personal fees from Lung-pacer (diaphragm pacing in the intensive care unit; Burnaby, Canada); he is listed as inventor or coinventor on several patents, granted or pending, describing a brain–ventilator interface. The other authors declare no competing interests.×
  • Correspondence: Address correspondence to Dr. Demoule: Service de Pneumologie et de Réanimation Médicale, Groupe Hospitalier Pitié-Salpêtrière, 47–83 Bld de l’Hôpital, 75651 Paris cedex 13, France. alexandre.demoule@aphp.fr. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Critical Care Medicine / Critical Care / Respiratory System
Critical Care Medicine   |   September 2017
Prevalence and Prognosis Impact of Patient–Ventilator Asynchrony in Early Phase of Weaning According to Two Detection Methods
Anesthesiology Newly Published on September 21, 2017. doi:10.1097/ALN.0000000000001886
Anesthesiology Newly Published on September 21, 2017. doi:10.1097/ALN.0000000000001886
Abstract

Background: Patient–ventilator asynchrony is associated with a poorer outcome. The prevalence and severity of asynchrony during the early phase of weaning has never been specifically described. The authors’ first aim was to evaluate the prognosis impact and the factors associated with asynchrony. Their second aim was to compare the prevalence of asynchrony according to two methods of detection: a visual inspection of signals and a computerized method integrating electromyographic activity of the diaphragm.

Methods: This was an ancillary study of a multicenter, randomized controlled trial comparing neurally adjusted ventilatory assist to pressure support ventilation. Asynchrony was quantified at 12, 24, 36, and 48 h after switching from controlled ventilation to a partial mode of ventilatory assistance according to the two methods. An asynchrony index greater than or equal to 10% defined severe asynchrony.

Results: A total of 103 patients ventilated for a median duration of 5 days (interquartile range, 3 to 9 days) were included. Whatever the method used for quantification, severe patient–ventilator asynchrony was not associated with an alteration of the outcome. No factor was associated with severe asynchrony. The prevalence of asynchrony was significantly lower when the quantification was based on flow and pressure than when it was based on the electromyographic activity of the diaphragm at 0.3 min–1 (interquartile range, 0.2 to 0.8 min–1) and 4.7 min–1 (interquartile range, 3.2 to 7.7 min–1; P < 0.0001), respectively.

Conclusions: During the early phase of weaning in patients receiving a partial ventilatory mode, severe patient–ventilator asynchrony was not associated with adverse clinical outcome, although the prevalence of patient–ventilator asynchrony varies according to the definitions and methods used for detection.