AUTHOR=Liu Ling , Yu Yue , Xu Xiaoting , Sun Qin , Qiu Haibo , Chiumello Davide , Yang Yi TITLE=Automatic Adjustment of the Inspiratory Trigger and Cycling-Off Criteria Improved Patient-Ventilator Asynchrony During Pressure Support Ventilation JOURNAL=Frontiers in Medicine VOLUME=8 YEAR=2021 URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.752508 DOI=10.3389/fmed.2021.752508 ISSN=2296-858X ABSTRACT=

Background: Patient-ventilator asynchrony is common during pressure support ventilation (PSV) because of the constant cycling-off criteria and variation of respiratory system mechanical properties in individual patients. Automatic adjustment of inspiratory triggers and cycling-off criteria based on waveforms might be a useful tool to improve patient-ventilator asynchrony during PSV.

Method: Twenty-four patients were enrolled and were ventilated using PSV with different cycling-off criteria of 10% (PS₁₀), 30% (PS₃₀), 50% (PS₅₀), and automatic adjustment PSV (PS_AUTO). Patient-ventilator interactions were measured.

Results: The total asynchrony index (AI) and NeuroSync index were consistently lower in PS_AUTO when compared with PS₁₀, PS₃₀, and PS₅₀, (P < 0.05). The benefit of PS_AUTO in reducing the total AI was mainly because of the reduction of the micro-AI but not the macro-AI. PS_AUTO significantly improved the relative cycling-off error when compared with prefixed controlled PSV (P < 0.05). PS_AUTO significantly reduced the trigger error and inspiratory effort for the trigger when compared with a prefixed trigger. However, total inspiratory effort, breathing patterns, and respiratory drive were not different among modes.

Conclusions: When compared with fixed cycling-off criteria, an automatic adjustment system improved patient-ventilator asynchrony without changes in breathing patterns during PSV. The automatic adjustment system could be a useful tool to titrate more personalized mechanical ventilation.