What type of asynchrony can you see? #1

31.05.2022
Author: Jorge Correia Crespo, Reviewer: Munir Karjaghli, Thomas Reimer

Is this a) auto-triggering, b) delayed triggering, c) double triggering, or d) delayed cycling?

(1) Positive deflection in flow;  (2) Ventilatory support delivered

Answer: Delayed triggering

You can see the increased time interval between the patient’s effort and the beginning of mechanical insufflation. The patient’s effort is indicated by the deflection in Flow visible here; a deflection in Paw would also be visible on the pressure waveform.

How to recognize it:

The time from the start of deflection until the ventilator detects the patient’s effort is longer than normal (> 200 ms). Did you know that patient-ventilator asynchronies occur in more than 25% of all mechanically ventilated patients1? See the possible causes and solutions listed below.

Common possible causes:

  • Trigger threshold set too high
  • Ventilator pneumatics
  • Presence of Auto-PEEP
  • Low respiratory drive
  • Weak inspiratory effort
  • Unintentional leaks

Solutions:

  • Decrease the inspiratory trigger setting
  • Increase the expiratory trigger sensitivity (ETS)
  • Shorten the inspiratory time (TI)

Reference: Thille AW, Intensive Care Med. 2006 | 2 Tassaux D, Am J Respir Crit Care Med. 2005 | 3 Blanch L, Intensive Care Med. 2015

Back

Date of Printing: 30.06.2022
Disclaimer:
The content of this newsletter is for informational purposes only and is not intended to be a substitute for professional training or for standard treatment guidelines in your facility. Any recommendations made in this newsletter with respect to clinical practice or the use of specific products, technology or therapies represent the personal opinion of the author only, and may not be considered as official recommendations made by Hamilton Medical AG. Hamilton Medical AG provides no warranty with respect to the information contained in this newsletter and reliance on any part of this information is solely at your own risk.
Date of Printing: 30.06.2022
Disclaimer:
The content of this Knowledge Base is intended for informational purposes only. Medin Medical AG provides no warranty with respect to the information contained in this Knowledge Base and reliance on any part of this information is solely at your own risk. For detailed instructions on operating your Medin Medical device, please refer to the official Medin Medical Operator’s Manual for the respective device.