EMERGENCY AND CRITICAL CARE
Waveform-based
management of patient–
ventilator synchronisation
A good knowledge of standard ventilator waveforms allows physicians to manage
patient-ventilator interaction at the bedside without the use of special technologies
Anita Orlando MD PhD
Department of
Anesthesia and Intensive
Care, Fondazione IRCCS
Policlinico San Matteo,
Pavia, Italy
Roberta Puce MD
Department of
Anesthesia and Intensive
Care, Fondazione IRCCS
Policlinico San Matteo,
Pavia, Italy
Eric Arisi MD
Department of Clinical,
Surgical, Diagnostic
and Pediatric Sciences,
Fondazione Policlinico
San Matteo, IRCCS,
University of Pavia, Pavia,
Italy
Francesco Mojoli MD
Department of Clinical,
Surgical, Diagnostic
and Pediatric Sciences,
Fondazione Policlinico
San Matteo, IRCCS,
University of Pavia;
Department of
Anesthesia and Intensive
Care, Fondazione IRCCS
Policlinico San Matteo,
Pavia, Italy
The novel approach of precision medicine is also
reaching the field of mechanical ventilation, with
the ultimate aim of customising ventilation and
providing patients with the highest quality
support. Big steps have been made by
manufacturers in the last years, with some new
technologies already available for clinical use and
which help optimise patient–ventilator
interaction. 1 However, the greatest effort still
comes from clinicians themselves, who should
examine the ventilator waveforms in order to
detect mismatches between patient and ventilator
inspiratory and expiratory times (these
phenomena are termed asynchronies). They are
observed frequently in ventilated patients and
represent a failure in providing them with
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optimal assistance. Asynchronies have negative
clinical consequences such as prolonged
mechanical ventilation, difficult weaning,
reduced comfort for the patient, increased risk of
diaphragmatic damage and potentially increased
morbidity and mortality. 2–6 Asynchronies can be
detected by looking at the ventilator waveforms
at the patient’s bedside 7,8 ; a good knowledge of
the phenomenon is therefore essential for
diagnosis and correction.
Classification of asynchronies
There are a few different classifications of
patient-ventilator asynchronies, each of them
considering a different aspect of the
phenomenon. 9,10