Keeping an eye on patient-ventilator synchrony
How to detect asynchronies? A digital eye
The well-trained eye of a ventilation expert is capable of detecting asynchronies by analyzing the shapes of the flow and pressure waveforms.
However, the patient’s condition can change from breath to breath and the expert cannot always be at the bedside.
That is where IntelliSync+ takes over. This technology mimics the expert‘s eye to identify signs of patient effort (trigger) or relaxation (cycling) on the waveform.
How does it work? IntelliSync+ principles
IntelliSync+ continuously analyzes waveform signals at least one hundred times per second. This enables IntelliSync+ to detect patient efforts immediately and to initiate inspiration and expiration in real time, thus replacing conventional trigger settings for inspiration and expiration.
For maximum flexibility, you can choose to activate IntelliSync+ for either the inspiratory trigger or the expiratory trigger, or both.
Are asynchronies really an issue? A look at the evidence
A high number of major patient-ventilator asynchronies occur in around 25% of all mechanically ventilated patients (Thille AW, Rodriguez P, Cabello B, Lellouche F, Brochard L. Patient-ventilator asynchrony during assisted mechanical ventilation. Intensive Care Med. 2006;32(10):1515-1522. doi:10.1007/s00134-006-0301-81). They are associated with increased work of breathing (Tassaux D, Gainnier M, Battisti A, Jolliet P. Impact of expiratory trigger setting on delayed cycling and inspiratory muscle workload. Am J Respir Crit Care Med. 2005;172(10):1283-1289. doi:10.1164/rccm.200407-880OC2), prolonged ventilation time (Thille AW, Rodriguez P, Cabello B, Lellouche F, Brochard L. Patient-ventilator asynchrony during assisted mechanical ventilation. Intensive Care Med. 2006;32(10):1515-1522. doi:10.1007/s00134-006-0301-81), and higher mortality (Blanch L, Villagra A, Sales B, et al. Asynchronies during mechanical ventilation are associated with mortality. Intensive Care Med. 2015;41(4):633-641. doi:10.1007/s00134-015-3692-63).
Analyzing waveform shapes is a reliable, accurate, and reproducible method for assessing patient-ventilator interaction. Automation of this method may allow continuous monitoring of ventilated patients and/or improved breath-triggering and cycling (Mojoli F, Iotti GA, Torriglia F, et al. In vivo calibration of esophageal pressure in the mechanically ventilated patient makes measurements reliable. Crit Care. 2016;20:98. Published 2016 Apr 11. doi:10.1186/s13054-016-1278-54).
How do you use it? IntelliSync+ setup and operation
IntelliSync+ is a completely noninvasive method that does not require any additional hardware or accessories. You just activate the option on your ventilator to use it in invasive and noninvasive ventilation modes on adult and pediatric patients.
As IntelliSync+ can also be combined with conventional triggers, you can choose to use IntelliSync+ either during inspiration or expiration, or both.