What factors can contribute to patient-ventilator asynchrony?

Patient-ventilator asynchrony occurs when the timing and synchronization between the patient’s spontaneous breathing efforts and the mechanical ventilatory support do not align, leading to discomfort, increased work of breathing, and potential respiratory failure.

Inappropriate ventilator settings can significantly contribute to this issue. For example, if the ventilator’s sensitivity settings are not well-calibrated, it may fail to recognize the patient's efforts to initiate a breath, leading to delayed ventilation or unnecessary assist breaths. This mismatch creates discomfort and can cause the patient to work harder to breathe against the machine.

Inadequate sedation plays a crucial role as well. If a patient is not sufficiently sedated, they may have strong respiratory drive or be agitated, which can further exacerbate the mismatch with the ventilator’s support. Sedation needs to be optimized to ensure that the patient’s breathing patterns are more in sync with the mechanical ventilation, thus reducing the chances of asynchrony.

While physician-related errors or equipment malfunctions can contribute to asynchrony, they are not the sole factors. Regularly scheduled sedation adjustments might also play a role, but they are more likely to ensure comfort rather than directly contributing to asynchrony when done appropriately. The key factors highlighted in the