What About Patient-Ventilator Interactions During Noninvasive Mechanical Ventilation?

Abstract

Over the past few years, the number of patients with acute and chronic respiratory failure undergoing non-invasive mechanical ventilation has increased. During mechanical ventilation patient-ventilator asynchrony can be realised. Patient-ventilator asynchrony is a mismatch among the patient’s respiratory neural pattern with respiratory frequency, initiation and termination of inspiration and pressurisation delivered by the ventilator. Different types of asynchronies can be realised. Leaks also represent a significant cause of asynchrony. Frequently in any diseases, residual obstructive events may occur: it is important to correct residual events and possible asynchronies to optimise therapy. Asynchronies during non-invasive mechanical ventilation can damage efficacy, cause discomfort and determine lack of tolerance on the part of the patient. For this reason it is necessary to monitor patient during non-invasive ventilation. The monitoring techniques are not standardised; mainly polysomnography is used but often also reduced respiratory monitoring. Currently, technological progress is developing devices capable of detecting asynchronous signals from the reading of flow and waveforms from the ventilator. The analysis of data provided by home mechanical ventilator might allow simplifying the monitoring of ventilation quality and limiting the indication for polysomnography or respiratory polygraphy to complex cases.