Dyssynchronies between inspiratory attempts of the patient and the inspiration by the ventilator could cause ventilator-induced lung injury (VILI). It is therefore important to recognize these dyssynchronies and act accordingly. On this page, you’ll find a quick overview of common dyssynchronies and how to treat them.
- Patient wants to inhale: neural signal travels to inspiratory muscles, inhalation begins
- Ventilator is immediately triggered as a result of the patient’s respiratory effort (triggering) and the ventilator immediately provides the inspiration
- Patient wants to exhale → ventilator opens the expiratory valve immediately (cycling)
- Exhalation is finished for both the patient and the ventilator; a new inhalation is possible
Patient ventilator dyssynchronies
There are 6 patient-ventilator dyssynchronies you should be able to recognize and treat. These are Delayed triggering, Ineffective triggering, Auto-triggering, Reverse triggering, Premature cycling and Delayed cycling. Read on below!
Patient wants to inhale, but the ventilator is late on delivery. This leads to increased work of breathing. Causes include muscle weakness, insensitive trigger and dynamic hyperinflation (intrinsic PEEP).
How to resolve Delayed triggering: increase trigger sensitivity.
In case of intrinsic PEEP, apply extrinsic PEEP (80% of intrinsic PEEP)
Patient wants to inhale, but the ventilator is does not deliver the inspiration. Causes include muscle weakness, insensitive trigger and dynamic hyperinflation (intrinsic PEEP).
How to resolve Ineffective triggering: see Delayed triggering.
Increase trigger sensitivity. In case of intrinsic…