Patient-Ventilator Asynchrony Recognition and Recommendations by Respiratory Therapists: A Bench Study

Abstract

Background:

Patient-ventilator asynchrony (PVA) occurs frequently and can lead to complications, such as increased work of breathing and longer mechanical ventilation duration. Asynchrony can potentially be improved by adjusting ventilator settings specific to the type of PVA. Sedation is sometimes used even though it may worsen PVAs and increase mechanical ventilation duration when used in the absence of other ventilator adjustments. Identifying and correcting PVAs is essential for respiratory therapists (RTs) to improve the quality of ventilator care. RTs have varying levels of comfort and knowledge for assessing the patient-ventilator relationship and making appropriate changes. This study aimed to determine whether RTs can recognize PVA and, if so, whether the RT can offer appropriate corrective actions.

Methods:

Twenty-one RTs from the Michigan Medicine Adult Respiratory Care Department volunteered. A Drager Evita Infinity V500 ventilator was attached to an Ingmar Medical ASL-5000. For each participant, four randomly assigned independent scenarios were simulated: control (synchronous), inspiratory PVA, cycle PVA, and trigger PVA. Each scenario included a patient history. The RT was instructed to ask for additional patient information as needed. During each scenario, the RT was asked to describe the patient’s breathing and to list interventions if needed. RTs were not able to physically change ventilator settings due to the model design. RTs' analysis of the scenario and suggested changes were recorded. During data analysis, interventions were classified as correct or incorrect for each PVA based on if it would improve the PVA. Sedation as a stand-alone intervention was marked as incorrect.

Results:

The control was correctly identified 100% (63/63) of the time. The presence of asynchrony was correctly identified 95.2% (60/63) of the time. RTs identified at least one correct intervention 76.2% (48/63) of the time. Sedation was included 39.7% (25/63) of the time as a possible intervention and as the only intervention 4.7% (3/63) of the time.

Conclusions:

In this bench model, RTs accurately identified the presence of PVA most of the time and were able to offer at least one correct intervention. The study suggests RTs do not solely rely on sedation to improve asynchrony but may frequently request it as part of the decision-making process. This study suggests an opportunity to improve PVA corrective actions, potentially through education and standardization of interventions.