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Asynchronies patient-ventilateur au cours de la ventilation assistée

Abstract : Major patient-ventilator asynchrony seems common on ventilator screen during assisted mechanical ventilation. Objectives: To evaluate the incidence of major asynchrony and to identify factors related to patient's characteristics and ventilator parameters associated with asynchrony, and to determine optimal ventilator adjustments. Methods: We evaluated the incidence of major patterns of asynchrony easily detected using a noninvasive method based on flow and airway pressure curves. In patients with frequent ineffective efforts we measured patient's effort using esophageal pressure measurements to optimize ventilatory settings. We evaluated the impact of ventilatory mode on sleep quality using a complete polysomnography. All intensive-care-unit ventilators were compared on a bench test in terms of trigger performance and pressurization capacity. Results: One-fourth of intubated patients exhibited major asynchrony. Duration of mechanical ventilation was longer and weaning more difficult in patients with asynchrony as compared to patients without asynchrony. Ineffective triggering was the main pattern of asynchrony and was promoted by excessive ventilatory assistance. Reducing the pressure-support completely eliminated ineffective efforts in most of patients, without inducing excessive respiratory muscle effort and without modifying the true patient's respiratory rate. Ventilatory mode did not influence sleep quality and asynchrony. Ineffective efforts were detected during both pressure-support ventilation and assist-control ventilation, and central apneas were not common using adequate level of pressure-support. Some ventilators exhibited poor performances which could promote patient-ventilator asynchrony. Conclusion: Patient-ventilator asynchrony is frequent during assisted ventilation and associated with prolonged duration of mechanical ventilation. Excessive ventilatory support could promote ineffective efforts although optimal ventilatory settings could minimize asynchrony. This work is a starting point to determine in a large study, whether optimization of ventilatory settings could shorten duration of mechanical ventilation.
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Arnaud Thille. Asynchronies patient-ventilateur au cours de la ventilation assistée. Médecine humaine et pathologie. Université Paris-Est, 2010. Français. ⟨NNT : 2010PEST0054⟩. ⟨tel-00667286⟩

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