Evaluation and Management of Ventilator-Patient Dyssynchrony

Mechanical ventilation in critically ill patients has to effectively unload inspiratory muscles and provide a safe ventilation (enhancing gas exchange and protecting the lungs and the diaphragm). To do that, the ventilator should be in synchrony with patient’s respiratory rhythm. Dyssynchrony between the patient and the ventilator may induce several deleterious effects, and a proper physiological understanding is required in order to recognize and manage. Different tools have been developed and proposed besides the careful analysis of the ventilator waveforms that aim to help physicians in the decision-making strategy. Additionally, appropriate handling of asynchronies requires clinical skills, physiological knowledge, and suitable drug management. Moreover, new technologies and devices are currently changing our daily practice, going from automated real-time recognition of asynchronies and their distribution during mechanical ventilation to smart-alarm-personalized medicine. Our goal as clinicians relies in careful care of patients based on the more accurate and current knowledge, and incorporate new technological methods that aims to facilitate and improve the care of the critically ill.