| Observational study of patient-ventilator asynchrony and relationship to sedation level. | |
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MedLine Citation:
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PMID: 19272542 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: Clinicians frequently administer sedation to facilitate mechanical ventilation. The purpose of this study was to examine the relationship between sedation level and patient-ventilator asynchrony. MATERIALS AND METHODS: Airway pressure and airflow were recorded for 15 minutes. Patient-ventilator asynchrony was assessed by determining the number of breaths demonstrating ineffective triggering, double triggering, short cycling, and prolonged cycling. Ineffective triggering index (ITI) was calculated by dividing the number of ineffectively triggered breaths by the total number of breaths (triggered and ineffectively triggered). Sedation level was assessed by the following 3 methods: Richmond Agitation-Sedation Scale (RASS), awake (yes or no), and delirium (Confusion Assessment Method for the intensive care unit [CAM-ICU]). RESULTS: Twenty medical ICU patients underwent 35 observations. Ineffective triggering was seen in 17 of 20 patients and was the most frequent asynchrony (88% of all asynchronous breaths), being observed in 9% +/- 12% of breaths. Deeper levels of sedation were associated with increasing ITI (awake, yes 2% vs no 11%; P < .05; CAM-ICU, coma [15%] vs delirium [5%] vs no delirium [2%]; P < .05; RASS, 0, 0% vs -5, 15%; P < .05). Diagnosis of chronic obstructive pulmonary disease, sedative type or dose, mechanical ventilation mode, and trigger method had no effect on ITI. CONCLUSIONS: Asynchrony is common, and deeper sedation level is a predictor of ineffective triggering. |
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Authors:
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Marjolein de Wit; Sammy Pedram; Al M Best; Scott K Epstein |
Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural Date: 2009-01-17 |
Journal Detail:
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Title: Journal of critical care Volume: 24 ISSN: 1557-8615 ISO Abbreviation: J Crit Care Publication Date: 2009 Mar |
Date Detail:
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Created Date: 2009-03-10 Completed Date: 2009-08-05 Revised Date: 2010-09-23 |
Medline Journal Info:
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Nlm Unique ID: 8610642 Medline TA: J Crit Care Country: United States |
Other Details:
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Languages: eng Pagination: 74-80 Citation Subset: IM |
Affiliation:
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Division of Pulmonary Disease and Critical Care Medicine, Department of Internal Medicine, Virginia Commonwealth University, Box 980050, Richmond, VA 23298-0050, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Analysis of Variance Conscious Sedation / adverse effects*, methods Critical Care Drug Monitoring / methods Equipment Failure Female Humans Male Middle Aged Monitoring, Physiologic / methods Pilot Projects Pulmonary Disease, Chronic Obstructive / physiopathology, therapy Respiration, Artificial / adverse effects*, instrumentation, methods Respiratory Insufficiency / metabolism, physiopathology, therapy Respiratory Mechanics / physiology* Risk Factors Sample Size Time Factors Virginia Wakefulness / drug effects |
| Grant Support | |
ID/Acronym/Agency:
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K23 GM068842/GM/NIGMS NIH HHS; K23 GM068842-03/GM/NIGMS NIH HHS; M01 RR000065-430609/RR/NCRR NIH HHS; M01 RR00065/RR/NCRR NIH HHS |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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