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Using ventilator waveform analysis to detect patient-ventilator asynchronies. The reference card

Asynchronies. The mismatch between patient and ventilator

Patient-ventilator asynchronies are a mismatch between the inspiratory and expiratory times of the patient and the ventilator. A common way to detect asynchronies is by examining ventilator waveforms. There are different types of asynchronies, each with a set of characteristics that can be visually recognized. The well trained eye can detect asynchronies by analyzing either the flow or pressure waveform (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.200407-880OC1​, 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/s00134-006-0301-82​, 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​, Mojoli et al. Automatic monitoring of plateau and driving pressure during pressure and volume controlled ventilation. Intensive Care Medicine Experimental 2015 3(Suppl 1):A998.4​).

Asynchrony reference cards Asynchrony reference cards

The reference card. The go-to document that helps you identify patient-ventilator asynchronies

To aid you in recognizing the tell-tale characteristics of each asynchrony, we have created a two-page reference card (also called "cheatsheet"), which you can download below.

It gives you a quick overview of:

  • The 7 main types of asynchronies

  • Indications on what to look for on the pressure or flow waveform

  • A visual example of the waveform with the most recognizable feature highlighted

  • Common possible causes for the different types of asynchrony

Submit the form. To receive it

Impact of expiratory trigger setting on delayed cycling and inspiratory muscle workload.

Authors: Didier Tassaux, Marc Gainnier, Anne Battisti, Philippe Jolliet

Patient-ventilator asynchrony during assisted mechanical ventilation.

Authors: Arnaud W Thille, Pablo Rodriguez, Belen Cabello, François Lellouche, Laurent Brochard

Asynchronies during mechanical ventilation are associated with mortality.

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

Automatic monitoring of plateau and driving pressure during pressure and volume controlled ventilation

Author: F Mojoli