Gal, N. (Nadien) (2013) Kunstmatige beademing op de pediatrische intensive care: Is er een verschil in optreden van patiënt-ventilator-asynchronie tijdens de volledige beademing en tijdens het weanen van de ventilator? thesis, Medicine.
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Abstract
Introduction: Although mechanical ventilation is an essential part of the treatment of critically ill patients admitted to intensive care, it is also associated with significant complications including patient-ventilator asynchrony (PVA). Among adults PVA is common during different phases of mechanical ventilation and is associated with increased morbidity and a smaller chance of success in the weaning off the ventilator. The occurrence of PVA in mechanically ventilated children has little been studied. The aim of this study was to test the hypothesis that PVA in mechanically ventilated children is also common during the weaning off the ventilator, but to a lesser extent than during full support. Materials and methods: All mechanically ventilated children aged 0 to 18 years who were able to initiate and maintain spontaneous breathing were eligible for inclusion since December 2012. Excluded were patients with congenital or acquired neuromuscular or nervous system disorders. PVA was identified by a random 15-minute continuous recording during two phases of the respiration and off-line analysis of the pressure-time and flow-time waveforms. PVA was categorized in to four different categories: 1) trigger asynchrony (i.e. ineffective trigger, double triggering, auto-triggering, or trigger delay), 2) flow asynchrony, 3) termination asynchrony (i.e. delayed or premature termination), and 4) expiratory asynchrony. Baseline demographic and clinical data were recorded. Data are expressed as mean ± standard deviation (SD), median (25th, 75th percentile), or percentage (%) of total. Results: 26 patients were included. Final analysis was performed on 15 patients. Total PVA and the eight different types of PVA were not significantly different between the two phases of mechanical ventilation. Respiratory rate, FiO2, PEEP and PIP were significantly lower in the weaning phase. Intensive triggers occurred more often in patients with high PVA index. Discussion and conclusion: Both during the full support and during the weaning, asynchrony occurred during one fifth of all breaths. Ineffective triggers contributed most to the development of PVA. Future research should determine the possible consequences of the occurrence of PVA during weaning in children.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Kneyber, Dr. Martin C.J. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:54 |
| Last Modified: | 25 Jun 2020 10:54 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1522 |
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