Table 3.

Markers of patient-ventilator dyssynchrony

Biological markers	Behavioral markers	Patients’ reports of breathing with the ventilator
Pressure/flow-time waveforms12,14 Tachycardia12,41 Tachypnea12,42 Decreased oxygen saturation12	Paradoxical thoracoabdominal breaths12 Nasal flaring12 Expiratory muscle activity, forceful exhalation12,41 Inspiratory intercostal retractions12 Increased movement of extremities43 Coughing44 Agitation12 Abdominal excursions12 Increased use of accessory muscles12 Inspiratory effort without triggering the ventilator12	Difficulty with sensations of altered ventilation: “Even on the ventilator, the rate didn’t bother me, it was the force of air”39 Difficulty breathing independently (forced to adapt to the machine): “Sometimes, it’s too fast for you. So instead of the machine synchronizing with you, you have to synchronize with the machine”39 Realized if they relaxed, their experience was easier: “I never had a feeling of suffocation like I thought I would if I became out of synch with the ventilator”39 Blamed clinicians for not providing information about being “out of synch”: “I was able to, in my own sort of way, put two and two together and figure, as soon as I get in sync here, that will stop”39 Subjects desired to know more about dyssynchrony: “To know that there may be a time where my breathing and the ventilator’s breathing are not going to match”39 Subjects desired that nurses provide coping strategies: Patients would prefer to know that “you can relax, and try to get back in sync with it, or let the nurses know that you’re waking up”39 Discomfort, breathlessness, air hunger12,15,41,45