Longitudinal Characterization of Patient-Ventilator Asynchronies in Acute Hypoxemic Respiratory Failure
Por:
de Haro, C, Xifra-Porxas, A, Batlle, M, Sarlabous, L, Santos-Pulpón, V, Mora, V, Suñol, F, Gomà, G, Estela, J, Subirà, C, López-Aguilar, J, Fernández-Gonzalo, S, Godoy-González, M, Fernández, R, Magrans, R, Telias, I, Roca, O, Brochard, L, Blanch, L
Publicada:
1 nov 2025
Ahead of Print:
1 may 2025
Resumen:
Background: We sought to analyze the prevalence of patient-ventilator asynchronies in subjects with hypoxemic respiratory failure because of COVID-19 ARDS and their association with clinical outcomes.Methods: This was a two-center observational cohort study using prospectively collected real-world data. We included adult subjects with COVID-19 ARDS who required mechanical ventilation for more than 48 hours. We analyzed the prevalence, characteristics, and clusters of the following patient-ventilator asynchronies detected using dedicated software on continuous respiratory recordings obtained from ventilators over the duration of mechanical ventilation (Better Care, Sabadell, Spain): double triggering, ineffective efforts (IE), and reverse triggering with and without breath-stacking (BS). The outcome measures evaluated were duration of invasive mechanical ventilation, ICU stay, and ICU mortality.Results: We analyzed 82 subjects with COVID-19 ARDS. Over the complete duration of mechanical ventilation, the most frequent asynchronies and related clusters were reverse triggering without BS (0.72% of breaths [interquartile range (IQR), 0.17-3.07]) and 4.6 clusters/d [IQR, 2.0-8.1] and double triggering (0.44% of breaths [IQR, 0.19-0.80]) and 4.6 clusters/d [IQR, 2.1-7.3]. The use of neuromuscular blockers was associated with a lower prevalence of double triggering and IE, but reverse triggering was not significantly reduced. Double triggering significantly increased with longer mechanical ventilation time, whereas reverse trigger significantly decreased during this period. Double triggering and clusters of double triggering were independently associated with longer mechanical ventilation duration and better ICU survival, whereas clusters of reverse triggering with BS were associated with longer duration of mechanical ventilation and ICU stay.Conclusions: Reverse triggering was the most prevalent asynchrony in subjects with ARDS COVID-19, decreased over time, and was followed by double triggering. Survivors had a higher prevalence of double triggering and clusters of double triggering, mostly occurring during spontaneous modes.
Filiaciones:
de Haro, C:
Univ Autonoma Barcelona, Parc Tauli Hosp Univ, Inst Invest Innovacio & Parc Tauli I3PT CERCA, Crit Care Dept, Sabadell, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Respiratorias C, Madrid, Spain
Inst Invest & Innovacio Parc Tauli I3PT CERCA, Grup Invest Traslac Pacient Crit, Sabadell, Spain
Xifra-Porxas, A:
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Respiratorias C, Madrid, Spain
Inst Invest & Innovacio Parc Tauli I3PT CERCA, Grup Invest Traslac Pacient Crit, Sabadell, Spain
Batlle, M:
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Respiratorias C, Madrid, Spain
Althaia Xarxa Assistencial Univ Manresa, Crit Care Dept, Manresa, Spain
IRIS Catalunya Cent & Grp Recerca Malalt Crit, Manresa, Spain
Sarlabous, L:
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Respiratorias C, Madrid, Spain
Inst Invest & Innovacio Parc Tauli I3PT CERCA, Grup Invest Traslac Pacient Crit, Sabadell, Spain
Santos-Pulpón, V:
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Respiratorias C, Madrid, Spain
Inst Invest & Innovacio Parc Tauli I3PT CERCA, Grup Invest Traslac Pacient Crit, Sabadell, Spain
Mora, V:
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Respiratorias C, Madrid, Spain
Inst Invest & Innovacio Parc Tauli I3PT CERCA, Grup Invest Traslac Pacient Crit, Sabadell, Spain
Suñol, F:
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Respiratorias C, Madrid, Spain
Inst Invest & Innovacio Parc Tauli I3PT CERCA, Grup Invest Traslac Pacient Crit, Sabadell, Spain
Gomà, G:
Univ Autonoma Barcelona, Parc Tauli Hosp Univ, Inst Invest Innovacio & Parc Tauli I3PT CERCA, Crit Care Dept, Sabadell, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Respiratorias C, Madrid, Spain
Estela, J:
Inst Invest & Innovacio Parc Tauli I3PT CERCA, Grup Invest Traslac Pacient Crit, Sabadell, Spain
Subirà, C:
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Respiratorias C, Madrid, Spain
Hosp Santa Creu I Sant Pau, Barcelona, Spain
López-Aguilar, J:
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Respiratorias C, Madrid, Spain
Inst Invest & Innovacio Parc Tauli I3PT CERCA, Grup Invest Traslac Pacient Crit, Sabadell, Spain
Fernández-Gonzalo, S:
Inst Invest & Innovacio Parc Tauli I3PT CERCA, Grup Invest Traslac Pacient Crit, Sabadell, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Salud Mental CIBERSAM, Madrid, Spain
Godoy-González, M:
Inst Invest & Innovacio Parc Tauli I3PT CERCA, Grup Invest Traslac Pacient Crit, Sabadell, Spain
Fernández, R:
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Respiratorias C, Madrid, Spain
Althaia Xarxa Assistencial Univ Manresa, Crit Care Dept, Manresa, Spain
IRIS Catalunya Cent & Grp Recerca Malalt Crit, Manresa, Spain
Magrans, R:
Better Care, Sabadell, Spain
Telias, I:
Li Ka Shing Knowledge Inst, Keenan Res Ctr Biomed Sci, Unity Hlth Toronto, Toronto, ON, Canada
Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada
Univ Hlth Network & Sinai Hlth Syst, Dept Med, Div Respirol, Toronto, ON, Canada
Roca, O:
Univ Autonoma Barcelona, Parc Tauli Hosp Univ, Inst Invest Innovacio & Parc Tauli I3PT CERCA, Crit Care Dept, Sabadell, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Respiratorias C, Madrid, Spain
Univ Autonoma Barcelona, Dept Med, Bellaterra, Spain
Brochard, L:
Li Ka Shing Knowledge Inst, Keenan Res Ctr Biomed Sci, Unity Hlth Toronto, Toronto, ON, Canada
Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada
Blanch, L:
Univ Autonoma Barcelona, Parc Tauli Hosp Univ, Inst Invest Innovacio & Parc Tauli I3PT CERCA, Crit Care Dept, Sabadell, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Respiratorias C, Madrid, Spain
Inst Invest & Innovacio Parc Tauli I3PT CERCA, Grup Invest Traslac Pacient Crit, Sabadell, Spain
Green Accepted
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