From the Guidelines
For a patient with ventilator dyssynchrony and normal oxygen saturation, I recommend optimizing ventilator settings through informed adjustment to minimize patient-ventilator asynchrony. This approach is supported by the British Thoracic Society (BTS) and Intensive Care Society (ICS) guideline for the ventilatory management of acute hypercapnic respiratory failure in adults 1. The guideline suggests that patient-ventilator asynchrony is common and deleterious, and can be minimized through informed adjustment of ventilator settings (Level 2+).
Key Considerations
- Patient-ventilator asynchrony can increase work of breathing, oxygen consumption, and risk of lung injury despite normal oxygen saturation.
- Optimizing ventilator settings, such as tidal volume, flow rate, and trigger sensitivity, can help minimize asynchrony.
- Proportional and NAVA (Neurally Adjusted Ventilatory Assist) have been shown experimentally to reduce ventilator asynchrony, but their impact on patient outcomes is still being studied 1.
Treatment Approach
- Start by optimizing the current ventilator settings to better match the patient's respiratory demands.
- Consider using proportional or NAVA modes if available, as they have been shown to reduce ventilator asynchrony experimentally 1.
- Monitor the patient closely for any changes in respiratory status and adjust ventilator settings as needed.
- If dyssynchrony persists, consider increasing sedation and analgesia, or using neuromuscular blocking agents, as these can help improve oxygenation and ventilation in cases of patient-ventilator dyssynchrony 1.