Evaluation of the Patient-ventilator Asynchrony During Mechanical Ventilation for Pediatric Acute Respiratory Failure
Condition: Mechanical Ventilation
MeSH terms: Respiratory Insufficiency
Study type: Observational

Summary: 
      The synchronization between the patient and the ventilator is an essential objective during
      mechanical ventilation (MV). Maintaining the patient's respiratory activity during MV reduces
      ventilation pressures, improves oxygenation, and decreases sedation. In order to do this, the
      inspiratory or expiratory effort of the patient must be detected by the respirator' sensor
      systems, so that the assistance delivered by the respirator is coordinated with the patient's
      respiratory cycles. The usual systems do not actually detect the beginning of the effort but
      its result: variation in flow rate or pressure at the respirator circuit, which depends on
      the patient's respiratory mechanics and sensitivity of the sensor. This detection is
      currently imperfect, which generates asynchrony between the patient's needs and the
      assistance of the respirator. The asynchrony comprises the periods of delay between the
      beginning of the inspiration (or expiration) and the response of the respirator, but also of
      the unsuitable cycles: inspiratory efforts of the patient not detected by the respirator, or
      inversely triggering assistance in the absence of inspiration by the patient
      (self-initiation), or delivery of 2 cycles of assistance for a single inspiration (double
      triggering).

      Asynchrony is a risk factor for prolonged mechanical ventilation in adults. Adult studies
      have shown that patient-ventilator asynchrony is common during MV, and is associated with
      prolonged MV duration. An association with length of stay in intensive care and in hospital
      was also observed. In children, patient-ventilator synchronization is more difficult to
      achieve than in adults due to a higher respiratory rate and smaller current volumes. The
      impact of patient-ventilator asynchrony on evolution has not been studied in pediatrics.

      Patient-ventilator synchronization could be improved by the development of new ventilatory
      modes. The new NAVA (neurally adjusted ventilatory assist) ventilation mode detects the
      patient's breathing efforts earlier by monitoring the electrical activity of the diaphragm
      through the esophagus. This new mode seems to improve synchronization in children. NAVA
      ventilation may therefore be a step forward, but its clinical benefits remain to be seen.

      The objective of this study is to evaluate the impact of patient-ventilator asynchrony on the
      duration of mechanical ventilation in children with acute respiratory failure.
    


Intervention name(s): Routine mechanical ventilation
Intervention type(s): Other
Intervention description(s): Routine mechanical ventilation in PICU amid children with acute respiratory failure
Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Patients under mechanical ventilation for acute respiratory failure
      
Keywords: intensive care