Table 2.
Characteristics of patients depending on the level of asynchrony (in patients with Edi > 2 µV, n = 34)
| % time spent in asynchrony < 39% (n = 25) | % time spent in asynchrony > 39% (n = 9) | p value | |
|---|---|---|---|
| Age (m) | 14 (2–40) | 2 (1–3) | 0.007 |
| Weight (kg) | 7.0 (4.5–17.3) | 4.3 (3.6–5.4) | 0.049 |
| Male, n (%) | 14 (56%) | 6 (67%) | 0.70 |
| Days between admission and inclusion | 8 (2–11) | 2 (1–5) | 0.054 |
| Main reasons for PICU admission, n (%) | 0.56 | ||
| Respiratory failure | 18 (72%) | 8 (89%) | 0.40 |
| Including bronchiolitis | 5 (20%) | 5 (56%) | 0.08 |
| Hemodynamic failure | 1 (4%) | 0 (0%) | 1 |
| Neurologic disorder | 3 (12%) | 0 (0%) | 0.55 |
| Metabolic disorder | 1 (4%) | 1 (11%) | 0.46 |
| Trauma | 0 (0%) | 0 (0%) | 1 |
| Post-surgery | 2 (8%) | 0 (0%) | 1 |
| Chronic condition, n (%) | |||
| Respiratory disease | 5 (20%) | 1 (11%) | 1 |
| Cardiac disease | 6 (24%) | 0 (0%) | 0.16 |
| Neurological disease | 6 (24%) | 1 (11%) | 0.64 |
| Immuno-oncologic disease | 3 (12%) | 0 (0%) | 0.55 |
| Clinical status | |||
| PIM-2 score | 2.5 (0.9–4.4) | 0.9 (0.5–7.0) | 0.40 |
| PELOD score | 1 (1–11) | 11 (1–12) | 0.38 |
| pH | 7.40 (7.33–7.42) | 7.37 (7.33–7.42) | 0.63 |
| HCO3 −, mmHg | 30.0 (25.1–32.9) | 28.8 (24.9–32.0) | 0.84 |
| PaCO2, mmHg | 48.0 (44.4–53.4) | 48.9 (45.8–57.5) | 0.57 |
| Hb, g/dL | 10.2 (7.3–10.7) | 10.4 (7.9–12.3) | 0.33 |
| Lactate, mmol/L | 1.5 (0.8–2.1) | 1.5 (1.2–1.9) | 1 |
| Comfort score | 15 (13–16) | 15 (11–17) | 0.95 |
| Sedation score | 11 (6–23) | 21 (11–39) | 0.15 |
| ETT size | 4.0 (3.5–4.5) | 3.5 (3.5–3.5) | 0.013 |
| Cuffed ETT | 17 (68%) | 2 (22%) | 0.019 |
| Ventilatory settings | |||
| Set RR | 25 (20–35) | 30 (28–38) | 0.13 |
| Measured RR | 34 (28–40) | 35 (29–40) | 0.92 |
| Mode PSV | 10 (40%) | 0 (0%) | 0.034 |
| Mode ACV-P | 4 (16%) | 3 (33%) | 0.35 |
| Mode IACV-P | 7 (28%) | 3 (33%) | 1 |
| Mode ACV-V | 0 (0%) | 0 (0%) | 1 |
| Mode IACV-V | 1 (4%) | 2 (22%) | 0.16 |
| Mode PRVC | 3 (12%) | 1 (11%) | 1 |
| PEEP, cmH2O | 5 (5–5) | 6 (5–7) | 0.06 |
| FiO2 | 0.35 (0.26–0.44) | 0.35 (0.30–0.60) | 0.45 |
| Leaks (%) | 7 (4–15) | 2 (0–7) | 0.17 |
| Analysis | |||
| Peak inspiratory Edi, µV | 7.2 (3.8–15.3) | 5.5 (3.4–7.2) | 0.20 |
| Tonic expiratory Edi, µV | 0.9 (0.6–2.4) | 2.0 (1.1–2.9) | 0.058 |
| Type of asynchrony | |||
| Wasted Efforts, % of breath analyzed | 4.5 (1.6–15.8) | 30.6 (18.7–39.8) | 0.002 |
| Auto-triggering, % of breath analyzed | 6.1 (1.3–9.9) | 8.4 (0.9–23.3) | 0.36 |
| Double triggering, % of breath analyzed | 2.1 (0.0–3.2) | 0.0 (0.0–0.8) | 0.08 |
| Trigger error, ms | 136 (104–176) | 284 (190–302) | 0.008 |
| Cycling-off error, ms | 64 (40–131) | 255 (184–297) | 0.018 |
| Time spent in asynchrony | |||
| Total time spent in asynchrony, % | 24 (17–28) | 47 (43–50) | < 0.001 |
| Wasted Effort, % | 0.6 (0.2–3.5) | 5.3 (2.8–13.6) | 0.03 |
| Auto-triggering, % | 1.6 (0.3–2.4) | 2.3 (0.3–4.7) | 0.40 |
| Double triggering, % | 0.1 (0.0–0.4) | 0.0 (0.0–0.1) | 0.053 |
| Trigger error | |||
| Delay, % | 7.6 (7.6–11.2) | 15.5 (12.2–19.1) | 0.001 |
| Premature, % | 0.8 (0.5–2.1) | 2.3 (1.4–2.9) | 0.058 |
| Cycle-off error | |||
| Delay, % | 3.8 (1.8–6.3) | 15.0 (10.2–17.5) | < 0.001 |
| Premature, % | 4.1 (2.2–5.9) | 3.2 (2.0–6.7) | 0.98 |
| NeuroSync index, % | 38 (31–47) | 81 (69–83) | < 0.001 |
| Outcome | |||
| Death in PICU | 1 (4.0%) | 1 (11.1%) | 1 |
| Days in PICU | 14 (5–22) | 7 (4–14) | 0.17 |
| Days in PICU after inclusion | 6 (4–12.5) | 5 (3–6) | 0.66 |
| Days on MV | 9 (4–15) | 4 (3–12) | 0.23 |
| Days on MV after inclusion | 2.5 (1–6.5) | 3 (1–4) | 0.9 |
| NIV post extubation | 4 (16.0%) | 1 (11.1%) | 1 |
| Reintubation | 5 (20.0%) | 1 (11.1%) | 1 |
Edi electrical activity of the diaphragm, PICU pediatric intensive care unit, RR respiratory rate, PSV pressure-support ventilation, ACV-P pressure-regulated assist control ventilation, IACV-P pressure-regulated intermittent assist control ventilation, ACV-V volume-regulated assist control ventilation, IACV-V volume-regulated intermittent assist control ventilation, PRVC pressure-regulated volume control ventilation, PEEP positive end-expiratory pressure, ETT endo-tracheal tube, MV mechanical ventilation, NIV noninvasive ventilation