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...

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Authors: de Haro López, Candelaria, Xifra Porxas, Alba, Batlle Perales, Montserrat, Sarlabous Uranga, Leonardo|||0000-0002-0495-8422, Santos Pulpón, Verónica, Mora Cuadrado, Víctor, Suñol Galofre, Francesc Xavier|||0000-0001-8947-7814, Gomà Fernández, Gemma, Estela Esteve, Júlia, Subirà Pifarré, Carles, López Aguilar, Josefina, Fernandez Gonzalo, Sol, Godoy González, Marta, Fernández Ruiz, Rafael, Magrans Nicieza, Rudys, Telias, Irene, Roca Gas, Oriol, Brochard, Laurent J., Blanch Torra, Lluis
Format: article
Publication Date:2025
Country:España
Institution:Universitat Politècnica de Catalunya (UPC)
Repository:UPCommons. Portal del coneixement obert de la UPC
Language:English
OAI Identifier:oai:upcommons.upc.edu:2117/433295
Online Access:https://hdl.handle.net/2117/433295
https://dx.doi.org/10.1089/respcare.12673
Access Level:Open access
Keyword:ARDS
Clusters of patient-ventilator asynchrony
Mortality
Neuromuscular blockers
Patient-ventilator asynchrony
Àrees temàtiques de la UPC::Enginyeria biomèdica
id ES_3fc9d65e649ade92b68f35099d4b2faa
oai_identifier_str oai:upcommons.upc.edu:2117/433295
network_acronym_str ES
network_name_str España
repository_id_str
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 López, Candelaria
ARDS
Clusters of patient-ventilator asynchrony
Mortality
Neuromuscular blockers
Patient-ventilator asynchrony
Àrees temàtiques de la UPC::Enginyeria biomèdica
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 López, Candelaria
Xifra Porxas, Alba
Batlle Perales, Montserrat
Sarlabous Uranga, Leonardo|||0000-0002-0495-8422
Santos Pulpón, Verónica
Mora Cuadrado, Víctor
Suñol Galofre, Francesc Xavier|||0000-0001-8947-7814
Gomà Fernández, Gemma
Estela Esteve, Júlia
Subirà Pifarré, Carles
López Aguilar, Josefina
Fernandez Gonzalo, Sol
Godoy González, Marta
Fernández Ruiz, Rafael
Magrans Nicieza, Rudys
Telias, Irene
Roca Gas, Oriol
Brochard, Laurent J.
Blanch Torra, Lluis
author de Haro López, Candelaria
author_facet de Haro López, Candelaria
Xifra Porxas, Alba
Batlle Perales, Montserrat
Sarlabous Uranga, Leonardo|||0000-0002-0495-8422
Santos Pulpón, Verónica
Mora Cuadrado, Víctor
Suñol Galofre, Francesc Xavier|||0000-0001-8947-7814
Gomà Fernández, Gemma
Estela Esteve, Júlia
Subirà Pifarré, Carles
López Aguilar, Josefina
Fernandez Gonzalo, Sol
Godoy González, Marta
Fernández Ruiz, Rafael
Magrans Nicieza, Rudys
Telias, Irene
Roca Gas, Oriol
Brochard, Laurent J.
Blanch Torra, Lluis
author_role author
author2 Xifra Porxas, Alba
Batlle Perales, Montserrat
Sarlabous Uranga, Leonardo|||0000-0002-0495-8422
Santos Pulpón, Verónica
Mora Cuadrado, Víctor
Suñol Galofre, Francesc Xavier|||0000-0001-8947-7814
Gomà Fernández, Gemma
Estela Esteve, Júlia
Subirà Pifarré, Carles
López Aguilar, Josefina
Fernandez Gonzalo, Sol
Godoy González, Marta
Fernández Ruiz, Rafael
Magrans Nicieza, Rudys
Telias, Irene
Roca Gas, Oriol
Brochard, Laurent J.
Blanch Torra, Lluis
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
Clusters of patient-ventilator asynchrony
Mortality
Neuromuscular blockers
Patient-ventilator asynchrony
Àrees temàtiques de la UPC::Enginyeria biomèdica
topic ARDS
Clusters of patient-ventilator asynchrony
Mortality
Neuromuscular blockers
Patient-ventilator asynchrony
Àrees temàtiques de la UPC::Enginyeria biomèdica
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
2025-05-29
2025
2025-07-01
dc.type.none.fl_str_mv journal article
http://purl.org/coar/resource_type/c_6501
AM
http://purl.org/coar/version/c_ab4af688f83e57aa
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://hdl.handle.net/2117/433295
https://dx.doi.org/10.1089/respcare.12673
url https://hdl.handle.net/2117/433295
https://dx.doi.org/10.1089/respcare.12673
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv SAGE publishing
publisher.none.fl_str_mv SAGE publishing
dc.source.none.fl_str_mv reponame:UPCommons. Portal del coneixement obert de la UPC
instname:Universitat Politècnica de Catalunya (UPC)
instname_str Universitat Politècnica de Catalunya (UPC)
reponame_str UPCommons. Portal del coneixement obert de la UPC
collection UPCommons. Portal del coneixement obert de la UPC
repository.name.fl_str_mv
repository.mail.fl_str_mv
_version_ 1869406684427845632
spelling Longitudinal characterization of patient-ventilator asynchronies in acute hypoxemic respiratory failurede Haro López, CandelariaXifra Porxas, AlbaBatlle Perales, MontserratSarlabous Uranga, Leonardo|||0000-0002-0495-8422Santos Pulpón, VerónicaMora Cuadrado, VíctorSuñol Galofre, Francesc Xavier|||0000-0001-8947-7814Gomà Fernández, GemmaEstela Esteve, JúliaSubirà Pifarré, CarlesLópez Aguilar, JosefinaFernandez Gonzalo, SolGodoy González, MartaFernández Ruiz, RafaelMagrans Nicieza, RudysTelias, IreneRoca Gas, OriolBrochard, Laurent J.Blanch Torra, LluisARDSClusters of patient-ventilator asynchronyMortalityNeuromuscular blockersPatient-ventilator asynchronyÀrees temàtiques de la UPC::Enginyeria biomèdicaBackground: 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.This work was funded by projects RTC-2017-6193-1 (AEI/FEDER EU) and 202118 (413/C/2021) Fundació La Marató de TV3, CIBER-Consorcio Centro de Investigación Biomédica en RED-CB06/06/1097, Instituto de Saludo Carlos III, Ministerio de Ciencia e Innovación and Unión Europea – European Regional Development Fund, CERCA Programme/Generalitat de Catalunya and Fundació Institut d’Investigació i Innovació Parc TaulíI3PT. C. de Haro is granted with a Contrato para la intensificación de la actividad investigadora en el sistema nacional de salud (INT20/00030), AES 2020, by Instituto de Salud Carlos III. L. Sarlabous is supported by Pla Estratègic de Recerca i Innovació en Salut program from the Health Department of Generalitat de Catalunya, Spain.Peer ReviewedSAGE publishing20252025-05-2920252025-07-01journal articlehttp://purl.org/coar/resource_type/c_6501AMhttp://purl.org/coar/version/c_ab4af688f83e57aainfo:eu-repo/semantics/articleapplication/pdfhttps://hdl.handle.net/2117/433295https://dx.doi.org/10.1089/respcare.12673reponame:UPCommons. Portal del coneixement obert de la UPCinstname:Universitat Politècnica de Catalunya (UPC)Inglésengopen accesshttp://purl.org/coar/access_right/c_abf2info:eu-repo/semantics/openAccessoai:upcommons.upc.edu:2117/4332952026-05-27T15:37:01Z
score 15.811543

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