Correction of Patient–Ventilator Discordance

Abstract

Optimizing the interaction between the patient and the ventilator should be a cornerstone for clinicians to pursue. Disruptions in these interactions can lead to what is called patient–ventilator discordance. Patient–ventilator discordance is a mismatch between what the patient desires in a breath and what the ventilator provides. Asynchrony is also a common term used to describe these unhealthy interactions. Different types of asynchronies make up the more global term of patient–ventilator discordance. Asynchronies can occur at the onset of a breath (trigger asynchrony), during breath delivery (flow asynchrony), or at the end of a breath (cycle asynchrony). Prompt identification and correction of these asynchronies is pivotal to prevent overuse of sedation, extended duration of mechanical ventilation, and perhaps an increased mortality risk. Clinicians must also take into consideration the phenomenon of ventilator-related dyspnea. Dyspnea is defined as a subjective feeling of breathing discomfort. In a ventilated patient dyspnea often goes unrecognized, as there is a communication barrier. Similar to the sensation of pain, recognizing and managing dyspnea is vital in mechanically ventilated patients.