Ventilator dyssynchrony - Detection, pathophysiology, and clinical relevance: A Narrative review.
Ventilator dyssynchrony - Detection, pathophysiology, and clinical relevance: A Narrative review.
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DOI：
10.4103/atm.atm_63_20
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发表时间：
2020-10
影响因子：
2.3
通讯作者：
Moss MM
中科院分区：
文献类型：
--
作者：
Sottile PD;Albers D;Smith BJ;Moss MM
与急性呼吸窘迫综合征相关的死亡率仍然高得令人无法接受，部分原因是呼吸机诱导的肺损伤（VILI）。呼吸机不同步被定义为响应于患者努力的机械呼吸的不适当定时和输送，并且可能导致VILI。这种有害的患者-呼吸机相互作用最近被称为患者自身造成的肺损伤。该叙述性综述概述了几种不同类型的呼吸机不同步的检测和频率，描述了呼吸机不同步可能传播VILI的不同机制，并综述了呼吸机不同步的潜在临床影响。直到最近，识别呼吸机不同步需要手动解释呼吸机压力和流量波形。然而，呼吸机放弃形式的计算机化解释可以检测到呼吸机不同步，受试者工作曲线下面积>0.80。使用这种算法，呼吸机不同步发生在所有呼吸的3%-34%中，这取决于患者群体。此外，与同步呼吸相比，两种类型的呼吸机不同步，双触发和流量限制呼吸，与更频繁的>10 mL/kg的大潮气量输送相关（54% [95%置信区间（CI），47%-61%]和11% [95% CI，7%-15%]）与0.9%（95% CI，0.0%-1.9%）相比，表明在传播VILI中的作用。最后，最近的一项研究将频繁的呼吸不同步（定义为>10%的呼吸）与医院死亡率的增加联系起来（67%对23%，P = 0.04）。然而，呼吸机不同步的临床意义仍然是一个积极的研究领域，需要更多的研究来指导最佳的呼吸机不同步管理。
Mortality associated with the acute respiratory distress syndrome remains unacceptably high due in part to ventilator-induced lung injury (VILI). Ventilator dyssynchrony is defined as the inappropriate timing and delivery of a mechanical breath in response to patient effort and may cause VILI. Such deleterious patient–ventilator interactions have recently been termed patient self-inflicted lung injury. This narrative review outlines the detection and frequency of several different types of ventilator dyssynchrony, delineates the different mechanisms by which ventilator dyssynchrony may propagate VILI, and reviews the potential clinical impact of ventilator dyssynchrony. Until recently, identifying ventilator dyssynchrony required the manual interpretation of ventilator pressure and flow waveforms. However, computerized interpretation of ventilator waive forms can detect ventilator dyssynchrony with an area under the receiver operating curve of >0.80. Using such algorithms, ventilator dyssynchrony occurs in 3%–34% of all breaths, depending on the patient population. Moreover, two types of ventilator dyssynchrony, double-triggered and flow-limited breaths, are associated with the more frequent delivery of large tidal volumes >10 mL/kg when compared with synchronous breaths (54% [95% confidence interval (CI), 47%–61%] and 11% [95% CI, 7%–15%]) compared with 0.9% (95% CI, 0.0%–1.9%), suggesting a role in propagating VILI. Finally, a recent study associated frequent dyssynchrony-defined as >10% of all breaths-with an increase in hospital mortality (67 vs. 23%, P = 0.04). However, the clinical significance of ventilator dyssynchrony remains an area of active investigation and more research is needed to guide optimal ventilator dyssynchrony management.