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Ventilator Dyssynchrony

What is ventilator dyssynchrony?
Occurs when the pattern or amount of gas delivery from the ventilator does not match the neural output from the patient’s respiratory center.

How is it recognized?
Use of accessory muscles, tachypnea, tachycardia, diaphoresis, nasal flaring and signs of respiratory distress on the ventilator

How to achieve synchrony?
Minimize auto-PEEP
Increase in inspiratory flow
A shortening of inspiratory time/prolongation of expiratory time
Increased sedation
Paralysis

Considerations in ARDS patients
Increase in respiratory rate (especially in ARDS as tidal volume is decreased – up to maximum 35 bpm in the ARDSnet study)
Increase tidal volume up to 8 mL/kg in the case of ventilator dyssynchrony (provided the plateau pressure remains <= 30 cm H2O)

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