RT Journal Article
SR Electronic
T1 Parasternal electromyography to determine the relationship between patient-ventilator asynchrony and nocturnal gas exchange during home mechanical ventilation set-up
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP 946
OP 952
DO 10.1136/thoraxjnl-2015-206944
VO 70
IS 10
A1 Ramsay, Michelle
A1 Mandal, Swapna
A1 Suh, Eui-Sik
A1 Steier, Joerg
A1 Douiri, Abdel
A1 Murphy, Patrick Brian
A1 Polkey, Michael
A1 Simonds, Anita
A1 Hart, Nicholas
YR 2015
UL http://thorax.bmj.com/content/70/10/946.abstract
AB Introduction Patient-ventilator asynchrony (PVA) can adversely affect the successful initiation of non-invasive home mechanical ventilation (HMV). The aim of this observational study was to quantify the prevalence of PVA during initiation of HMV and to determine the relationship between PVA and nocturnal gas exchange.Method Type and frequency of PVA were measured by surface parasternal intercostal muscle electromyography, thoracoabdominal plethysmography and mask pressure during initiation of HMV. Severe PVA was defined, as previously, as asynchrony affecting ≥10% of breaths.Results 28 patients (18 male) were enrolled aged 61±15 years and with a body mass index of 35±9 kg/m2. Underlying diagnoses were neuromuscular disease with or without chest wall disease (n=6), obesity related chronic respiratory failure (n=12) and COPD (n=10). PVA was observed in all patients with 79% of patients demonstrating severe PVA. Triggering asynchrony was most frequent, observed in 24% (IQR: 11–36%) of breaths, with ineffective efforts accounting for 16% (IQR: 4–24%). PVA types were similar between disease groups, with the exception of auto-triggering, which was higher in patients with COPD (12% (IQR: 6–26%)). There was no correlation observed between PVA and time spent with oxygen saturations ≤90%, mean oxygen saturations or transcutaneous carbon dioxide levels during overnight ventilation.Conclusions Severe PVA was identified in the majority of patients, irrespective of pathophysiological disease state. This was not associated with ineffective ventilation as evidenced by gas exchange.