Patient-ventilator asynchrony in conventional ventilation modes during short-term mechanical ventilation after cardiac surgery: randomized clinical trial

Wagner Souza Leite; Alita Novaes; Monique Bandeira; Emanuelle Olympia Ribeiro; Alice Miranda dos Santos; Pedro Henrique de Moura; Caio César Morais; Catarina Rattes; Maria Karoline Richtrmoc; Juliana Souza; Gustavo Henrique Correia de Lima; Norma Sueli Pinheiro Modolo; Antonio Christian Evangelista Gonçalves; Carlos Alfredo Ramirez Gonzalez; Maria do Amparo Andrade; Armèle Dornelas De Andrade; Daniella Cunha Brandão; Shirley Lima Campos

doi:10.4081/mrm.2020.650

Patient-ventilator asynchrony in conventional ventilation modes during short-term mechanical ventilation after cardiac surgery: randomized clinical trial

Authors

Wagner Souza Leite Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco
Alita Novaes Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco
Monique Bandeira Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco
Emanuelle Olympia Ribeiro Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco
Alice Miranda dos Santos Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco
Pedro Henrique de Moura Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco
Caio César Morais Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston
Catarina Rattes Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco
Maria Karoline Richtrmoc Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco
Juliana Souza Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco
Gustavo Henrique Correia de Lima Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco
Norma Sueli Pinheiro Modolo Department of Anaesthesiology, Institute of Bioscience, School of Medicine, UNESP-Universidade Estadual Paulista, Botucatu, São Paulo
Antonio Christian Evangelista Gonçalves Department of Anaesthesiology, Institute of Bioscience, School of Medicine, UNESP-Universidade Estadual Paulista, Botucatu, São Paulo
Carlos Alfredo Ramirez Gonzalez Hospital Monsenhor Walfredo Gurgel, Natal, Rio Grande do Norte
Maria do Amparo Andrade Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco
Armèle Dornelas De Andrade Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco
Daniella Cunha Brandão Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco
Shirley Lima Campos Department of Physical Therapy, Universidade Federal de Pernambuco, Recife, Pernambuco

DOI: https://doi.org/10.4081/mrm.2020.650

Keywords:

ventilator weaning, thoracic surgery, breath triggering, cycle synchrony

Abstract

Introduction and aim: Studies regarding asynchrony in patients in the cardiac postoperative period are still only a few. The main objective of our study was to compare asynchronies incidence and its index (AI) in 3 different modes of ventilation (volume-controlled ventilation [VCV], pressure-controlled ventilation [PCV] and pressure-support ventilation [PSV]) after ICU admission for postoperative care. Methods: A prospective parallel randomised trial in the setting of a non-profitable hospital in Brazil. The participants were patients scheduled for cardiac surgery. Patients were randomly allocated to VCV or PCV modes of ventilation and later both groups were transitioned to PSV mode. Results: All data were recorded for 5 minutes in each of the three different phases: T1) in assisted breath, T2) initial spontaneous breath and T3) final spontaneous breath, a marking point prior to extubation. Asynchronies were detected and counted by visual inspection method by two independent investigators. Reliability, inter-rater agreement of asynchronies, asynchronies incidence, total and specific asynchrony indexes (AIt and AIspecific) and odds of AI ≥10% weighted by total asynchrony were analysed. A total of 17 patients randomly allocated to the VCV (n= 9) or PCV (n=8) group completed the study. High inter-rated agreement for AIt (ICC 0.978; IC95%, 0,963-0.987) and good reliability (r=0.945; p<0.001) were found. Eighty-two % of patients presented asynchronies, although only 7% of their total breathing cycles were asynchronous. Early cycling and double triggering had the highest rates of asynchrony with no difference between groups. The highest odds of AI ≥10% were observed in VCV regardless the phase: OR 2.79 (1.36-5.73) in T1 vs T2, p=0.005; OR 2.61 (1.27-5.37) in T1 vs T3, p=0.009 and OR 4.99 (2.37-10.37) in T2 vs T3, p<0.001. Conclusions: There was a high incidence of breathing asynchrony in postoperative cardiac patients, especially when initially ventilated in VCV. VCV group had a higher chance of AI ≥10% and this chance remained high in the following PSV phases.

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