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 Tecnologie

IntelliSync®+: per non perdere di vista la sincronia paziente-ventilatore

Occhio umano che acquisisce ed elabora dati digitali

Come si rilevano le asincronie? Un occhio digitale

L'occhio addestrato di un esperto di ventilazione è in grado di rilevare le asincronie esaminando la forma delle curve di flusso e pressione.

Tuttavia, le condizioni del paziente possono cambiare anche nell'arco di un singolo respiro e l'esperto non può restare sempre accanto al letto.

È qui che entra in gioco IntelliSync+. Questa tecnologia si comporta come l'occhio di un esperto per identificare sulla curva i segni dello sforzo (trigger) o del rilassamento (ciclaggio) del paziente.

Confronto prima e dopo IntelliSync

Come funziona? I principi alla base di IntelliSync+

IntelliSync+ analizza costantemente le curve dei segnali, almeno cento volte al secondo. In questo modo, IntelliSync+ è in grado di rilevare immediatamente gli sforzi del paziente e iniziare l'inspirazione e l'espirazione in tempo reale, sostituendo così le convenzionali impostazioni dei trigger per inspirazione ed espirazione.

Per garantire la massima flessibilità, si può attivare IntelliSync+ solo per il trigger inspiratorio, solo per il trigger espiratorio oppure per entrambi.

Illustrazione: cartella clinica e occhiali

Le asincronie sono davvero un problema? Uno sguardo alle prove

In circa il 25% del totale dei pazienti ventilati meccanicamente si verifica un numero elevato di asincronie paziente-ventilatore importanti (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). Queste asincronie sono associate a un aumento del lavoro 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), a una durata prolungata della ventilazione (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) e a una maggiore mortalità (Blanch L, Villagra A, Sales B, et al. Le asincronie durante la ventilazione meccanica sono legate alla mortalità. Intensive Care Med. 2015;41(4):633-641. doi:10.1007/s00134-015-3692-63).

L'analisi della forma delle curve è un metodo affidabile, accurato e riproducibile per valutare l'interazione tra paziente e ventilatore. Automatizzando questo processo è possibile monitorare continuativamente i pazienti ventilati e/o migliorare il trigger e il ciclaggio della respirazione (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. Pubblicato l'11 aprile 2016. doi:10.1186/s13054-016-1278-54).

Bibliografia: le asincronie (PDF)

Ciclaggio automatico per una migliore sincronia paziente-ventilatore

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

In un recente studio, il controllo automatico del ciclaggio del ventilatore basato sull'analisi delle curve in tempo reale si è dimostrato un metodo affidabile per il miglioramento della sincronizzazione nei pazienti sottoposti a ventilazione meccanica.
Ulteriori dettagli
Display del ventilatore Display del ventilatore

Come si usa? Configurazione e utilizzo di IntelliSync+

IntelliSync+ è un metodo assolutamente non invasivo che non richiede alcun hardware o accessorio aggiuntivo. Basta attivare l'opzione corrispondente sul ventilatore per utilizzarlo nelle modalità di ventilazione non invasive o invasive, su pazienti adulti e pediatrici.

Poiché IntelliSync+ può essere combinato anche con i trigger convenzionali, si può scegliere di utilizzare IntelliSync+ per l'inspirazione, l'espirazione o entrambe.

Illustrazione: studentessa che stringe in mano un diploma

Buono a sapersi! Risorse per la formazione su IntelliSync+

Per iniziare a studiare
Scheda di riferimento sulle asincronie

Imparare a notare le più comuni asincronie: scheda di riferimento gratuita

La nostra scheda di riferimento sulle asincronie fornisce una panoramica sui tipi più comuni di asincronie, sulle loro cause e su come individuarle.

Scaricare la scheda di riferimento

Disponibilità

IntelliSync+ è disponibile come opzione sui ventilatori HAMILTON-C6 e HAMILTON-G5, è invece una funzione standard sul ventilatore HAMILTON-S1.

HAMILTON-C6

HAMILTON-C6

Per ulteriori informazioni

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

Bibliografia

  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

Note

 

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)