成人危重症患者呼吸机不同步：频率和类型。
Patient ventilator asynchrony in critically ill adults: frequency and types.
机构信息
Department of Acute and Continuing Care, School of Nursing, University of Texas Health, Health Science Center at Houston, 6901 Bertner Avenue, Houston, TX 77030, USA.
Department of Adult Health and Nursing Systems, School of Nursing, Virginia Commonwealth University, 1100 East Leigh St., P.O. Box 980567, Richmond, VA 23298-0567, USA.
出版信息
Heart Lung. 2014 May-Jun;43(3):231-43. doi: 10.1016/j.hrtlng.2014.02.002.
BACKGROUND
Patient ventilator asynchrony (PVA) occurs frequently, but little is known about the types and frequency of PVA. Asynchrony is associated with significant patient discomfort, distress and poor clinical outcomes (duration of mechanical ventilation, intensive care unit and hospital stay).
METHODS
Pressure-time and flow-time waveform data were collected on 27 ICU patients using the Noninvasive Cardiac Output monitor for up to 90 min per subject and blinded waveform analysis was performed.
RESULTS
PVA occurred during all phases of ventilated breaths and all modes of ventilation. The most common type of PVA was Ineffective Trigger. Ineffective trigger occurs when the patient's own breath effort will not trigger a ventilator breath. The overall frequency of asynchronous breaths in the sample was 23%, however 93% of the sample experienced at least one incident of PVA during their observation period. Seventy-seven percent of subjects experienced multiple types of PVA.
CONCLUSIONS
PVA occurs frequently in a variety of types although the majority of PVA is ineffective trigger. The study uncovered previously unidentified waveforms that may indicate that there is a greater range of PVAs than previously reported. Newly described PVA, in particular, PVA combined in one breath, may signify substantial patient distress or poor physiological circumstance that clinicians should investigate.
背景
患者呼吸机不同步（PVA）经常发生，但对于 PVA 的类型和频率知之甚少。不同步与患者明显的不适、痛苦和不良临床结局（机械通气时间、重症监护病房和住院时间）有关。
方法
使用无创心输出量监测仪对 27 名 ICU 患者进行长达 90 分钟的压力-时间和流量-时间波形数据采集，对采集到的波形进行盲法分析。
结果
PVA 发生在所有通气呼吸的阶段和所有通气模式中。最常见的 PVA 类型是无效触发。无效触发是指患者自身的呼吸努力不会触发呼吸机呼吸。在样本中，异步呼吸的总体频率为 23%，但在观察期间，93%的样本至少发生过一次 PVA 事件。77%的研究对象经历了多种类型的 PVA。
结论
尽管大多数 PVA 是无效触发，但 PVA 以各种类型频繁发生。该研究揭示了以前未识别的波形，这可能表明存在比以前报告的更多类型的 PVA。特别是新描述的 PVA，即一次呼吸中同时出现多种 PVA，可能表明患者存在严重的不适或不良生理状况，临床医生应对此进行调查。
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