Asynchronies during mechanical ventilation are associated with mortality.

Blanch, Lluís; Villagra, Ana; Sales, Bernat; Montanya, Jaume; Lucangelo, Umberto; Luján, Manel; García-Esquirol, Oscar; Chacón, Encarna; Estruga, Anna; Oliva, Joan C; Hernández-Abadia, Alberto; Albaiceta, Guillermo M; Fernández-Mondejar, Enrique; Fernández, Rafael; Lopez-Aguilar, Josefina; Villar, Jesús; Murias, Gastón; Kacmarek, Robert M

PURPOSE This study aimed to assess the prevalence and time course of asynchronies during mechanical ventilation (MV). METHODS Prospective, noninterventional observational study of 50 patients admitted to intensive care unit (ICU) beds equipped with Better Care™ software throughout MV. The software distinguished ventilatory modes and detected ineffective inspiratory efforts during expiration (IEE), double-triggering, aborted inspirations, and short and prolonged cycling to compute the asynchrony index (AI) for each hour. We analyzed 7,027 h of MV comprising 8,731,981 breaths. RESULTS Asynchronies were detected in all patients and in all ventilator modes. The median AI was 3.41 % [IQR 1.95-5.77]; the most common asynchrony overall and in each mode was IEE [2.38 % (IQR 1.36-3.61)]. Asynchronies were less frequent from 12 pm to 6 am [1.69 % (IQR 0.47-4.78)]. In the hours where more than 90 % of breaths were machine-triggered, the median AI decreased, but asynchronies were still present. When we compared patients with AI > 10 vs AI ≤ 10 %, we found similar reintubation and tracheostomy rates but higher ICU and hospital mortality and a trend toward longer duration of MV in patients with an AI above the cutoff. CONCLUSIONS Asynchronies are common throughout MV, occurring in all MV modes, and more frequently during the daytime. Further studies should determine whether asynchronies are a marker for or a cause of mortality.