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Optimizing Mechanical Ventilation: A Clinical and Practical Bedside Method for the Identification and Management of Patient-Ventilator Asynchronies in Critical Care.
J Clin Med
January 2025
Department of Critical Care Medicine, Hospital de São Francisco Xavier, Unidade Local de Saúde Lisboa Ocidental (ULSLO), Estrada Forte do Alto Duque, 1449-005 Lisbon, Portugal.
The prompt identification and correction of patient-ventilator asynchronies (PVA) remain a cornerstone for ensuring the quality of respiratory failure treatment and the prevention of further injury to critically ill patients. These disruptions, whether due to over- or under-assistance, have a profound clinical impact not only on the respiratory mechanics and the mortality associated with mechanical ventilation but also on the patient's cardiac output and hemodynamic profile. Strong evidence has demonstrated that these frequently occurring and often underdiagnosed events have significant prognostic value for mechanical ventilation outcomes and are strongly associated with prolonged ICU stays and hospital mortality.
View Article and Find Full Text PDFIs Reverse-Triggering in Pressure Support Ventilation an Oxymoron? Maybe Not!
Am J Respir Crit Care Med
November 2024
University of Trento, Cismed, Trento, Italy.
Management of sedation during weaning from mechanical ventilation.
Curr Opin Crit Care
February 2025
Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago, Chicago, Illinois, USA.
Article Synopsis
- Critically ill patients often need mechanical ventilation and sedation for comfort, and managing sedation is crucial for successful weaning from ventilation.
- There is evidence supporting light sedation practices and simultaneous spontaneous awakening and breathing trials, yet these methods are not consistently applied in clinical settings.
- Prioritizing analgesia over sedatives and using tools like dexmedetomidine can aid in the weaning process, but more research is needed, especially for patients with acute respiratory distress syndrome (ARDS).
Does patient-ventilator asynchrony really matter?
Curr Opin Crit Care
February 2025
Keenan Centre for Biomedical Research, Li Ka Shing Knowledge Institute, Unity Health Toronto.
Purpose Of Review: Past observational studies have reported the association between patient-ventilator asynchronies and poor clinical outcomes, namely longer duration of mechanical ventilation and higher mortality. But causality has remained undetermined. During the era of lung and diaphragm protective ventilation, should we revolutionize our clinical practice to detect and treat dyssynchrony?
Recent Findings: Clinicians' ability to recognize asynchronies is typically low.
Noninvasive neurally-adjusted ventilatory assist in preterm infants: a systematic review and meta-analysis.
J Matern Fetal Neonatal Med
December 2024
Graduate School of Nursing Sciences, Global Health Nursing, St Luke's International University, Tokyo, Japan.
Background: Noninvasive neurally-adjusted ventilatory assist (NIV-NAVA) improves patient-ventilator synchrony and may reduce treatment failure in preterm infants compared with nasal continuous positive airway pressure (NCPAP) and noninvasive positive-pressure ventilation (NIPPV). We conducted a systematic review and meta-analysis to assess the effects of NIV-NAVA in preterm infants with respiratory distress.
Methods: Four investigators independently assessed the eligibility of studies in CENTRAL, CINAHL, ClinicalTrials.
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