Longitudinal Characterization of Patient-Ventilator Asynchronies in Acute Hypoxemic Respiratory Failure

Background: We sought to analyze the prevalence of patient-ventilator asynchronies in subjects with hypoxemic respiratory failure because of COVID-19 ARDS and their association with clinical outcomes.Methods: This was a two-center observational cohort study using prospectively collected real-world d...

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Autores: de Haro, C, Xifra-Porxas, A, Batlle, M, Sarlabous, L, Santos-Pulpón, V, Mora, V, Suñol, F, Gomà, G, Estela, J, Subirà, C, López-Aguilar, J, Fernández-Gonzalo, S, Godoy-González, M, Fernández, R, Magrans, R, Telias, I, Roca, O, Brochard, L, Blanch, L
Formato: artículo
Estado:Versión publicada
Fecha de publicación:2025
País:España
Recursos:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
Repositorio:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
OAI Identifier:oai:iibsantpau.fundanetsuite.com:p20537
Acesso em linha:https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=20537
Access Level:acceso abierto
Palavra-chave:ARDS
patient-ventilator asynchrony
clusters of patient-ventilator asynchrony
neuromuscular blockers
mortality
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spelling Longitudinal Characterization of Patient-Ventilator Asynchronies in Acute Hypoxemic Respiratory Failurede Haro, CXifra-Porxas, ABatlle, MSarlabous, LSantos-Pulpón, VMora, VSuñol, FGomà, GEstela, JSubirà, CLópez-Aguilar, JFernández-Gonzalo, SGodoy-González, MFernández, RMagrans, RTelias, IRoca, OBrochard, LBlanch, LARDSpatient-ventilator asynchronyclusters of patient-ventilator asynchronyneuromuscular blockersmortalityBackground: We sought to analyze the prevalence of patient-ventilator asynchronies in subjects with hypoxemic respiratory failure because of COVID-19 ARDS and their association with clinical outcomes.Methods: This was a two-center observational cohort study using prospectively collected real-world data. We included adult subjects with COVID-19 ARDS who required mechanical ventilation for more than 48 hours. We analyzed the prevalence, characteristics, and clusters of the following patient-ventilator asynchronies detected using dedicated software on continuous respiratory recordings obtained from ventilators over the duration of mechanical ventilation (Better Care, Sabadell, Spain): double triggering, ineffective efforts (IE), and reverse triggering with and without breath-stacking (BS). The outcome measures evaluated were duration of invasive mechanical ventilation, ICU stay, and ICU mortality.Results: We analyzed 82 subjects with COVID-19 ARDS. Over the complete duration of mechanical ventilation, the most frequent asynchronies and related clusters were reverse triggering without BS (0.72% of breaths [interquartile range (IQR), 0.17-3.07]) and 4.6 clusters/d [IQR, 2.0-8.1] and double triggering (0.44% of breaths [IQR, 0.19-0.80]) and 4.6 clusters/d [IQR, 2.1-7.3]. The use of neuromuscular blockers was associated with a lower prevalence of double triggering and IE, but reverse triggering was not significantly reduced. Double triggering significantly increased with longer mechanical ventilation time, whereas reverse trigger significantly decreased during this period. Double triggering and clusters of double triggering were independently associated with longer mechanical ventilation duration and better ICU survival, whereas clusters of reverse triggering with BS were associated with longer duration of mechanical ventilation and ICU stay.Conclusions: Reverse triggering was the most prevalent asynchrony in subjects with ARDS COVID-19, decreased over time, and was followed by double triggering. Survivors had a higher prevalence of double triggering and clusters of double triggering, mostly occurring during spontaneous modes.DAEDALUS ENTERPRISES INC2025info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=20537Respiratory CareISSN: 00201324ISSNe: 19433654reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pauinstname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)Inglésinfo:eu-repo/semantics/openAccessoai:iibsantpau.fundanetsuite.com:p205372026-06-14T12:41:47Z
dc.title.none.fl_str_mv Longitudinal Characterization of Patient-Ventilator Asynchronies in Acute Hypoxemic Respiratory Failure
title Longitudinal Characterization of Patient-Ventilator Asynchronies in Acute Hypoxemic Respiratory Failure
spellingShingle Longitudinal Characterization of Patient-Ventilator Asynchronies in Acute Hypoxemic Respiratory Failure
de Haro, C
ARDS
patient-ventilator asynchrony
clusters of patient-ventilator asynchrony
neuromuscular blockers
mortality
title_short Longitudinal Characterization of Patient-Ventilator Asynchronies in Acute Hypoxemic Respiratory Failure
title_full Longitudinal Characterization of Patient-Ventilator Asynchronies in Acute Hypoxemic Respiratory Failure
title_fullStr Longitudinal Characterization of Patient-Ventilator Asynchronies in Acute Hypoxemic Respiratory Failure
title_full_unstemmed Longitudinal Characterization of Patient-Ventilator Asynchronies in Acute Hypoxemic Respiratory Failure
title_sort Longitudinal Characterization of Patient-Ventilator Asynchronies in Acute Hypoxemic Respiratory Failure
dc.creator.none.fl_str_mv de Haro, C
Xifra-Porxas, A
Batlle, M
Sarlabous, L
Santos-Pulpón, V
Mora, V
Suñol, F
Gomà, G
Estela, J
Subirà, C
López-Aguilar, J
Fernández-Gonzalo, S
Godoy-González, M
Fernández, R
Magrans, R
Telias, I
Roca, O
Brochard, L
Blanch, L
author de Haro, C
author_facet de Haro, C
Xifra-Porxas, A
Batlle, M
Sarlabous, L
Santos-Pulpón, V
Mora, V
Suñol, F
Gomà, G
Estela, J
Subirà, C
López-Aguilar, J
Fernández-Gonzalo, S
Godoy-González, M
Fernández, R
Magrans, R
Telias, I
Roca, O
Brochard, L
Blanch, L
author_role author
author2 Xifra-Porxas, A
Batlle, M
Sarlabous, L
Santos-Pulpón, V
Mora, V
Suñol, F
Gomà, G
Estela, J
Subirà, C
López-Aguilar, J
Fernández-Gonzalo, S
Godoy-González, M
Fernández, R
Magrans, R
Telias, I
Roca, O
Brochard, L
Blanch, L
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv ARDS
patient-ventilator asynchrony
clusters of patient-ventilator asynchrony
neuromuscular blockers
mortality
topic ARDS
patient-ventilator asynchrony
clusters of patient-ventilator asynchrony
neuromuscular blockers
mortality
description Background: We sought to analyze the prevalence of patient-ventilator asynchronies in subjects with hypoxemic respiratory failure because of COVID-19 ARDS and their association with clinical outcomes.Methods: This was a two-center observational cohort study using prospectively collected real-world data. We included adult subjects with COVID-19 ARDS who required mechanical ventilation for more than 48 hours. We analyzed the prevalence, characteristics, and clusters of the following patient-ventilator asynchronies detected using dedicated software on continuous respiratory recordings obtained from ventilators over the duration of mechanical ventilation (Better Care, Sabadell, Spain): double triggering, ineffective efforts (IE), and reverse triggering with and without breath-stacking (BS). The outcome measures evaluated were duration of invasive mechanical ventilation, ICU stay, and ICU mortality.Results: We analyzed 82 subjects with COVID-19 ARDS. Over the complete duration of mechanical ventilation, the most frequent asynchronies and related clusters were reverse triggering without BS (0.72% of breaths [interquartile range (IQR), 0.17-3.07]) and 4.6 clusters/d [IQR, 2.0-8.1] and double triggering (0.44% of breaths [IQR, 0.19-0.80]) and 4.6 clusters/d [IQR, 2.1-7.3]. The use of neuromuscular blockers was associated with a lower prevalence of double triggering and IE, but reverse triggering was not significantly reduced. Double triggering significantly increased with longer mechanical ventilation time, whereas reverse trigger significantly decreased during this period. Double triggering and clusters of double triggering were independently associated with longer mechanical ventilation duration and better ICU survival, whereas clusters of reverse triggering with BS were associated with longer duration of mechanical ventilation and ICU stay.Conclusions: Reverse triggering was the most prevalent asynchrony in subjects with ARDS COVID-19, decreased over time, and was followed by double triggering. Survivors had a higher prevalence of double triggering and clusters of double triggering, mostly occurring during spontaneous modes.
publishDate 2025
dc.date.none.fl_str_mv 2025
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=20537
url https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=20537
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv DAEDALUS ENTERPRISES INC
publisher.none.fl_str_mv DAEDALUS ENTERPRISES INC
dc.source.none.fl_str_mv Respiratory Care
ISSN: 00201324
ISSNe: 19433654
reponame:r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
instname:Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
instname_str Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau)
reponame_str r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
collection r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,811543

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