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Original Research |

Patient-Ventilator Asynchrony During Noninvasive VentilationAsynchrony During Noninvasive Ventilation: A Bench and Clinical Study

Guillaume Carteaux, MD; Aissam Lyazidi, PhD; Ana Cordoba-Izquierdo, MD; Laurence Vignaux; Philippe Jolliet, MD; Arnaud W. Thille, MD, PhD; Jean-Christophe M. Richard, MD, PhD; Laurent Brochard, MD
Author and Funding Information

From the Réanimation Médicale (Drs Carteaux, Lyazidi, Cordoba-Izquierdo, Thille, and Brochard), AP-HP, Groupe Hospitalier Albert Chenevier-Henri Mondor; INSERM Unité 955 (Equipe 13) (Drs Carteaux, Lyazidi, Cordoba-Izquierdo, Thille, and Brochard), Université Paris EST, Créteil, France; the Department of Intensive Care (Ms Vignaux and Dr Brochard), Geneva University Hospital and Geneva University, Geneva; the Service de Médecine Intensive Adulte et Centre des brulés (Dr Jolliet), Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; the Faculté de biologie et de medicine (Dr Jolliet), Université de Lausanne, Lausanne, Switzerland; and the Réanimation médicale (Dr Richard), Centre Hospitalier Universitaire Charles Nicolle, Rouen, France.

Correspondence to: Guillaume Carteaux, MD, Service de Réanimation Médicale, Hôpital Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny 94010 Créteil, France; e-mail: guillaume.carteaux@yahoo.fr


For editorial comment see page 274

Funding/Support: This study was supported in part by a research grant from Philips Respironics (€10,000). This study was performed while Dr Carteaux was funded by an institutional grant, the Année Recherche, from the Ministère de l’éducation nationale, de l’enseignement supérieur et de la recherche (French Ministry for Education and Research).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(2):367-376. doi:10.1378/chest.11-2279
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Background:  Different kinds of ventilators are available to perform noninvasive ventilation (NIV) in ICUs. Which type allows the best patient-ventilator synchrony is unknown. The objective was to compare patient-ventilator synchrony during NIV between ICU, transport—both with and without the NIV algorithm engaged—and dedicated NIV ventilators.

Methods:  First, a bench model simulating spontaneous breathing efforts was used to assess the respective impact of inspiratory and expiratory leaks on cycling and triggering functions in 19 ventilators. Second, a clinical study evaluated the incidence of patient-ventilator asynchronies in 15 patients during three randomized, consecutive, 20-min periods of NIV using an ICU ventilator with and without its NIV algorithm engaged and a dedicated NIV ventilator. Patient-ventilator asynchrony was assessed using flow, airway pressure, and respiratory muscles surface electromyogram recordings.

Results:  On the bench, frequent auto-triggering and delayed cycling occurred in the presence of leaks using ICU and transport ventilators. NIV algorithms unevenly minimized these asynchronies, whereas no asynchrony was observed with the dedicated NIV ventilators in all except one. These results were reproduced during the clinical study: The asynchrony index was significantly lower with a dedicated NIV ventilator than with ICU ventilators without or with their NIV algorithm engaged (0.5% [0.4%-1.2%] vs 3.7% [1.4%-10.3%] and 2.0% [1.5%-6.6%], P < .01), especially because of less auto-triggering.

Conclusions:  Dedicated NIV ventilators allow better patient-ventilator synchrony than ICU and transport ventilators, even with their NIV algorithm. However, the NIV algorithm improves, at least slightly and with a wide variation among ventilators, triggering and/or cycling off synchronization.

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