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 Tecnología

IntelliSync®+. Con la vista puesta en la sincronización entre paciente y respirador

Ojo humano que captura y procesa datos digitales

¿Cómo podemos detectar las asincronías? Con un ojo digital

El ojo entrenado de un experto en ventilación es capaz de detectar asincronías analizando las formas de onda de presión o de flujo.

Sin embargo, el estado del paciente puede cambiar entre una respiración y otra y el experto no siempre se encuentra en junto al paciente.

Aquí es donde toma el control el IntelliSync+. Esta tecnología imita el ojo experto para identificar los signos de esfuerzo (disparo) o de relajación (ciclado) del paciente en la forma de onda.

InelliSync antes y después

¿Cómo funciona? Principios de IntelliSync+

IntelliSync+ analiza de manera continua las señales de las formas de onda al menos cien veces por segundo. Esto permite a IntelliSync+ detectar el esfuerzo del paciente de manera inmediata e iniciar la inspiración y la espiración en tiempo real, lo que sustituye los ajustes de disparo de inspiración y espiración convencionales.

Para ofrecer la máxima flexibilidad, puede optar por activar IntelliSync+ para automatizar el disparo inspiratorio o el disparo espiratorio, o ambos.

Ilustración gráfica: carpeta de paciente con lupa

¿Son las asincronías verdaderamente un problema? Examinemos las pruebas

Se observó un elevado número de asincronías importantes entre el paciente y el respirador en el 25 % de todos los pacientes con ventilación mecánica (Thille AW, Rodriguez P, Cabello B, Lellouche F, Brochard L. Patient-ventilator asynchrony during assisted mechanical ventilation. Intensive Care Med. 2006;32(10):1515-1522. doi:10.1007/s00134-006-0301-81). Estos se asociaron con un mayor esfuerzo respiratorio (Tassaux D, Gainnier M, Battisti A, Jolliet P. Impact of expiratory trigger setting on delayed cycling and inspiratory muscle workload. Am J Respir Crit Care Med. 2005;172(10):1283-1289. doi:10.1164/rccm.200407-880OC2), un mayor tiempo de ventilación (Thille AW, Rodriguez P, Cabello B, Lellouche F, Brochard L. Patient-ventilator asynchrony during assisted mechanical ventilation. Intensive Care Med. 2006;32(10):1515-1522. doi:10.1007/s00134-006-0301-81) y una mayor mortalidad (Blanch L, Villagra A, Sales B, et al. Asynchronies during mechanical ventilation are associated with mortality. Intensive Care Med. 2015;41(4):633-641. doi:10.1007/s00134-015-3692-63).

El análisis de formas de onda es un método fiable, preciso y reproducible para evaluar la interacción entre el paciente y el respirador. La automatización de este método permite una monitorización continua de los pacientes ventilados o una mejor activación de la respiración y del ciclado (Mojoli F, Iotti GA, Torriglia F, et al. In vivo calibration of esophageal pressure in the mechanically ventilated patient makes measurements reliable. Crit Care. 2016;20:98. Published 2016 Apr 11. doi:10.1186/s13054-016-1278-54).

Bibliografía: Asincronías (PDF)

Ciclos de apagado inspiratorio automáticos para una mejor sincronización entre el paciente y el respirador

Mojoli F, Orlando A, Bianchi IM, et al.

Un estudio reciente mostró que el control automatizado de los ciclos de apagado inspiratorio del respirador basado en el análisis en tiempo real de las formas de onda proporcionó un medio fiable para mejorar la sincronización en pacientes con ventilación mecánica.
Más información
Pantalla del respirador Pantalla del respirador

¿Cómo se usa? Configuración y funcionamiento de IntelliSync+

IntelliSync+ es un método completamente no invasivo que no requiere ningún accesorio ni hardware adicionales. Basta con activar la opción en el respirador para utilizarlo con los modos de ventilación invasiva o no invasiva en pacientes adultos y pediátricos.

Dado que IntelliSync+ también puede utilizarse en combinación con los disparos convencionales, tiene la posibilidad de elegir cuándo utilizar IntelliSync+, es decir, durante la inspiración, la espiración o con ambas.

Ilustración gráfica: estudiante con certificación en la mano

¡Siga aprendiendo! Recursos de formación sobre IntelliSync+

Comience a formarse aquí
Hoja de referencia de asincronías

Aprenda a detectar las asincronías más comunes. Hoja de referencia gratuita

Nuestra hoja de referencia de asincronías incluye una descripción general de los tipos de asincronías más comunes, sus causas y cómo detectarlas.

Descargar hoja de referencia

Disponibilidad

IntelliSync+ está disponible de forma opcional para el HAMILTON-C6 y el HAMILTON-G5, y se incluye de serie en el HAMILTON-S1.

HAMILTON-C6

HAMILTON-C6

Más información

Documento
IntelliSync+ brochure
inglés | 4,48 MB | ELO20240217N.00
Documento
Asynchronies bibliography
inglés | 0,67 MB | ELO20190906S.00
Documento
How to improve patient-ventilator synchrony whitepaper
inglés | 5,75 MB | ELO20171207S.00
Mostrar más

Referencias

  1. 1. Thille AW, Rodriguez P, Cabello B, Lellouche F, Brochard L. Patient-ventilator asynchrony during assisted mechanical ventilation. Intensive Care Med. 2006;32(10):1515-1522. doi:10.1007/s00134-006-0301-8
  2. 2. Tassaux D, Gainnier M, Battisti A, Jolliet P. Impact of expiratory trigger setting on delayed cycling and inspiratory muscle workload. Am J Respir Crit Care Med. 2005;172(10):1283-1289. doi:10.1164/rccm.200407-880OC

 

  1. 3. Blanch L, Villagra A, Sales B, et al. Asynchronies during mechanical ventilation are associated with mortality. Intensive Care Med. 2015;41(4):633-641. doi:10.1007/s00134-015-3692-6
  2. 4. Mojoli F, Iotti GA, Torriglia F, et al. In vivo calibration of esophageal pressure in the mechanically ventilated patient makes measurements reliable. Crit Care. 2016;20:98. Published 2016 Apr 11. doi:10.1186/s13054-016-1278-5

Notas al pie

 

Patient-ventilator asynchrony during assisted mechanical ventilation.

Thille AW, Rodriguez P, Cabello B, Lellouche F, Brochard L. Patient-ventilator asynchrony during assisted mechanical ventilation. Intensive Care Med. 2006;32(10):1515-1522. doi:10.1007/s00134-006-0301-8



OBJECTIVE

The incidence, pathophysiology, and consequences of patient-ventilator asynchrony are poorly known. We assessed the incidence of patient-ventilator asynchrony during assisted mechanical ventilation and we identified associated factors.

METHODS

Sixty-two consecutive patients requiring mechanical ventilation for more than 24 h were included prospectively as soon as they triggered all ventilator breaths: assist-control ventilation (ACV) in 11 and pressure-support ventilation (PSV) in 51.

MEASUREMENTS

Gross asynchrony detected visually on 30-min recordings of flow and airway pressure was quantified using an asynchrony index.

RESULTS

Fifteen patients (24%) had an asynchrony index greater than 10% of respiratory efforts. Ineffective triggering and double-triggering were the two main asynchrony patterns. Asynchrony existed during both ACV and PSV, with a median number of episodes per patient of 72 (range 13-215) vs. 16 (4-47) in 30 min, respectively (p=0.04). Double-triggering was more common during ACV than during PSV, but no difference was found for ineffective triggering. Ineffective triggering was associated with a less sensitive inspiratory trigger, higher level of pressure support (15 cmH(2)O, IQR 12-16, vs. 17.5, IQR 16-20), higher tidal volume, and higher pH. A high incidence of asynchrony was also associated with a longer duration of mechanical ventilation (7.5 days, IQR 3-20, vs. 25.5, IQR 9.5-42.5).

CONCLUSIONS

One-fourth of patients exhibit a high incidence of asynchrony during assisted ventilation. Such a high incidence is associated with a prolonged duration of mechanical ventilation. Patients with frequent ineffective triggering may receive excessive levels of ventilatory support.

Impact of expiratory trigger setting on delayed cycling and inspiratory muscle workload.

Tassaux D, Gainnier M, Battisti A, Jolliet P. Impact of expiratory trigger setting on delayed cycling and inspiratory muscle workload. Am J Respir Crit Care Med. 2005;172(10):1283-1289. doi:10.1164/rccm.200407-880OC



RATIONALE

During pressure-support ventilation, the ventilator cycles into expiration when inspiratory flow decreases to a given percentage of peak inspiratory flow ("expiratory trigger"). In obstructive disease, the slower rise and decrease of inspiratory flow entails delayed cycling, an increase in intrinsic positive end-expiratory pressure, and nontriggering breaths.

OBJECTIVES

We hypothesized that setting expiratory trigger at a higher than usual percentage of peak inspiratory flow would attenuate the adverse effects of delayed cycling.

METHODS

Ten intubated patients with obstructive disease undergoing pressure support were studied at expiratory trigger settings of 10, 25, 50, and 70% of peak inspiratory flow.

MEASUREMENTS

Continuous recording of diaphragmatic EMG activity with surface electrodes, and esophageal and gastric pressures with a dual-balloon nasogastric tube.

MAIN RESULTS

Compared with expiratory trigger 10, expiratory trigger 70 reduced the magnitude of delayed cycling (0.25 +/- 0.18 vs. 1.26 +/- 0.72 s, p < 0.05), intrinsic positive end-expiratory pressure (4.8 +/- 1.9 vs. 6.5 +/- 2.2 cm H(2)O, p < 0.05), nontriggering breaths (2 +/- 3 vs. 9 +/- 5 breaths/min, p < 0.05), and triggering pressure-time product (0.9 +/- 0.8 vs. 2.1 +/- 0.7 cm H2O . s, p < 0.05).

CONCLUSIONS

Setting expiratory trigger at a higher percentage of peak inspiratory flow in patients with obstructive disease during pressure support improves patient-ventilator synchrony and reduces inspiratory muscle effort. Further studies should explore whether these effects can influence patient outcome.

Asynchronies during mechanical ventilation are associated with mortality.

Blanch L, Villagra A, Sales B, et al. Asynchronies during mechanical ventilation are associated with mortality. Intensive Care Med. 2015;41(4):633-641. doi:10.1007/s00134-015-3692-6



PURPOSE

This study aimed to assess the prevalence and time course of asynchronies during mechanical ventilation (MV).

METHODS

Prospective, noninterventional observational study of 50 patients admitted to intensive care unit (ICU) beds equipped with Better Care™ software throughout MV. The software distinguished ventilatory modes and detected ineffective inspiratory efforts during expiration (IEE), double-triggering, aborted inspirations, and short and prolonged cycling to compute the asynchrony index (AI) for each hour. We analyzed 7,027 h of MV comprising 8,731,981 breaths.

RESULTS

Asynchronies were detected in all patients and in all ventilator modes. The median AI was 3.41 % [IQR 1.95-5.77]; the most common asynchrony overall and in each mode was IEE [2.38 % (IQR 1.36-3.61)]. Asynchronies were less frequent from 12 pm to 6 am [1.69 % (IQR 0.47-4.78)]. In the hours where more than 90 % of breaths were machine-triggered, the median AI decreased, but asynchronies were still present. When we compared patients with AI > 10 vs AI ≤ 10 %, we found similar reintubation and tracheostomy rates but higher ICU and hospital mortality and a trend toward longer duration of MV in patients with an AI above the cutoff.

CONCLUSIONS

Asynchronies are common throughout MV, occurring in all MV modes, and more frequently during the daytime. Further studies should determine whether asynchronies are a marker for or a cause of mortality.

In vivo calibration of esophageal pressure in the mechanically ventilated patient makes measurements reliable.

Mojoli F, Iotti GA, Torriglia F, et al. In vivo calibration of esophageal pressure in the mechanically ventilated patient makes measurements reliable. Crit Care. 2016;20:98. Published 2016 Apr 11. doi:10.1186/s13054-016-1278-5

In screening programmes it is important to assess a preliminary effectiveness of the screening method as soon as possible in order to forecast survival figures. In March 1981 a controlled single-view mammographic screening trial for breast cancer was started in the south of Stockholm. The population invited for screening mammography consisted of 40,000 women aged 40-64 years, and 20,000 women served as a well-defined control group. The main aim of the trial was to determine whether repeated mammographic screening could reduce the mortality in the study population (SP) compared to the control population (CP). The cumulative number of advanced mammary carcinomas in the screening and the control populations from the first five years of screening have shown a tendency towards more favourable stages in the screened population aged 40-64 years. A breakdown by age suggests an effect in age group 50-59 years, but not yet in age groups 40-49 and 60-64 years. When comparing the rates of stage II+ cancer, an increased number is found in the study group. As the total rate of breast cancer is higher in SP than in CP, there ought to be a concealed group of stage II+ cancers in the CP which makes the comparison biased. A new approach has been designed, where an estimation of the 'hidden' number of stage II+ cancers in CP is added to the clinically detected cases, and in this respect a comparison has shown a decrease in the cumulative number of advanced cancers in the SP in relation to the CP (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)