Document Detail


Observational study of patient-ventilator asynchrony and relationship to sedation level.
MedLine Citation:
PMID:  19272542     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Marjolein de Wit; Sammy Pedram; Al M Best; Scott K Epstein
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2009-01-17
Journal Detail:
Title:  Journal of critical care     Volume:  24     ISSN:  1557-8615     ISO Abbreviation:  J Crit Care     Publication Date:  2009 Mar 
Date Detail:
Created Date:  2009-03-10     Completed Date:  2009-08-05     Revised Date:  2010-09-23    
Medline Journal Info:
Nlm Unique ID:  8610642     Medline TA:  J Crit Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  74-80     Citation Subset:  IM    
Affiliation:
Division of Pulmonary Disease and Critical Care Medicine, Department of Internal Medicine, Virginia Commonwealth University, Box 980050, Richmond, VA 23298-0050, USA.
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MeSH Terms
Descriptor/Qualifier:
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:
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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