Table 1.
Characteristics and outcomes of patients with and without PVA
| Patient characteristics and outcomes | Patients without PVA | Patients with nonrecurrent PVA | Patients with recurrent PVA | |||
|---|---|---|---|---|---|---|
| Number of patients | 85 | 18 | 17 | |||
| Median number of asynchrony episodes | NA | 1 | 3 | |||
| IQR | NA | NA | 2–5 | |||
| Range | NA | NA | 2–21 | |||
| Age (years) | 63.8 ± 13.4 | 66.5 ± 10.3 | 67.7 ± 9.1 | |||
| Female (%) | 33 (38.8) | 7 (38.9) | 5 (29.4) | |||
| APACHE II score | 26.1 ± 8.6 | 27.2 ± 7.4 | 29.1 ± 6.4 | |||
| ARDS (%) | 24 (28.2) | 6 (33.3) | 10 (58.8)* | |||
| Height (m) | 1.6 ± 0.11 | 1.57 ± 0.1 | 1.61 ± 0.11 | |||
| Weight (kg) | 63.5 ± 17.3 | 61.2 ± 13.8 | 64.8 ± 17.5 | |||
| Primary diagnosis (%) | ||||||
| Pneumonia | 25 (29.4) | 7 (38.9) | 9 (52.9) | |||
| Other sepsis | 15 (17.7) | 3 (16.7) | 3 (17.7) | |||
| COPD | 3 (3.5) | 0 (0) | 0 (0) | |||
| Asthma | 3 (3.5) | 1 (5.6) | 1 (5.9) | |||
| Stroke | 8 (9.4) | 3 (16.7) | 2 (11.8) | |||
| Othera | 31 (36.5) | 4 (22.2) | 2 (11.8) | |||
| Comorbidity (%) | ||||||
| Diabetes mellitus | 36 (42.4) | 7 (38.9) | 4 (23.5) | |||
| Hypertension | 48 (56.5) | 9 (50) | 11 (64.7) | |||
| Ischemic heart disease | 18 (21.2) | 4 (22.2) | 3 (17.7) | |||
| Chronic heart failure | 3 (3.5) | 1 (5.6) | 0 (0) | |||
| Asthma | 7 (8.2) | 0 (0) | 2 (11.8) | |||
| COPD | 4 (4.7) | 1 (5.6) | 0 (0) | |||
| Chronic kidney disease | 17 (20) | 1 (5.6) | 3 (17.7) | |||
| Chronic liver disease | 15 (17.7) | 3 (16.7) | 3 (17.7) | |||
| Stroke | 3 (3.5) | 1 (5.6) | 0 (0) | |||
| Cancer | 13 (15.3) | 2 (11.1) | 4 (23.5) | |||
| ICU admission parameters | ||||||
| Temperature (Celsius) | 36.9 ± 1.2 | 36.7 ± 1.3 | 36.8 ± 1 | |||
| Heart rate (beats/min) | 99 ± 26 | 105 ± 27 | 107 ± 20 | |||
| MAP (mmHg) | 94 ± 23 | 91 ± 24 | 97 ± 17 | |||
| Respiratory rate (/min) | 24 ± 6 | 25 ± 6 | 24 ± 6 | |||
| ICU admission ABG | ||||||
| pH | 7.33 ± 0.15 | 7.31 ± 0.18 | 7.36 ± 0.14 | |||
| pCO2 (mmHg) | 42.0 ± 19.2 | 34.0 ± 8.6 | 46.4 ± 23.9 | |||
| Bicarbonate (mmol/L) | 20.8 ± 6.1 | 18.8 ± 7.3 | 23.5 ± 4.9 | |||
| Ventilation mode on ICU admission (%) | ||||||
| Volume assist control | 84 (98.8) | 16 (88.9)* | 16 (94.1) | |||
| Pressure assist control | 0 (0) | 2 (11.1) | 1 (5.9) | |||
| Pressure support | 1 (1.2) | 0 (0) | 0 (0) | |||
| Ventilation parameters on ICU admissionb | Ne | Ne | Ne | |||
| FIO2 | 0.68 ± 0.16 | 85 | 0.74 ± 0.12 | 18 | 0.69 ± 0.2 | 17 |
| PEEP (cmH2O) | 5.8 ± 1.7 | 85 | 5.6 ± 1.6 | 18 | 6.2 ± 2.2 | 17 |
| Tidal volume (ml/kg IBW) | 7.2 ± 1.7 | 73 | 7.9 ± 2 | 14 | 7 ± 0.8 | 12 |
| Driving pressure (cmH2O) | 11.7 ± 4.7 | 59 | 12.7 ± 5.1 | 13 | 11.1 ± 5.8 | 10 |
| Analgesia/sedation usec | ||||||
| Fentanyl (%) | 78 (91.8) | 17 (94.4) | 17 (100) | |||
| Propofol (%) | 75 (88.2) | 18 (100) | 17 (100) | |||
| Midazolam (%) | 5 (5.9) | 1 (5.6) | 1 (5.9) | |||
| Dexmedetomidine (%) | 9 (10.6) | 2 (11.1) | 9 (52.9)* | |||
| Median fluid balance at 24 h after ICU admission (IQR) (ml) | 669 (105–1600) | 1415 (503–2300) | 650 (305–1333) | |||
| Vasopressor use on ICU admission (%) | 36 (42.4) | 11 (61.1) | 8 (47.1) | |||
| Median ventilator-free days through day 28 (IQR) | 25 (23–26) | 23.5 (21–25)* | 18 (10–23)* | |||
| Median sedation-free days through day 28 (IQR) | 26 (25–27) | 25.5 (24–27) | 22 (18–26)* | |||
| Median ICU LOS (IQR) | 6 (4–9) | 7.5 (4–11) | 12 (7–18)* | |||
| Median hospital LOS (IQR) | 14 (8–31) | 12.5 (8–35)* | 17 (12–28) | |||
| ICU mortality (%) | 10 (11.8) | 5 (27.8) | 7 (41.2)* | |||
| Hospital mortality (%) | 12 (14.1) | 5 (27.8) | 7 (41.2)* | |||
| ICU mortality (OR, 95% CI) | ||||||
| Unadjusted | Reference | 2.88 (0.85–9.81) | 5.25 (1.62–16.91) | |||
| Adjustedd | Reference | 2.51 (0.71–8.93) | 4.35 (1.17–16.24) | |||
| Hospital mortality (OR, 95% CI) | ||||||
| Unadjusted | Reference | 2.34 (0.71–7.76) | 4.26 (1.36–13.35) | |||
| Adjustedd | Reference | 2.07 (0.6–7.17) | 3.81 (1.05–13.82) | |||
ABG, arterial blood gas; APACHE, acute physiology and chronic health evaluation; ARDS, acute respiratory distress syndrome; BP, blood pressure; CI, confidence interval; COPD, chronic obstructive pulmonary disease; and IBW, IBW: ideal body weight. For males, IBW = 50 kg + 2.3 kg for each increment of 2.54 cm (1 inch) in length over 152.4 cm (5 feet). For females, IBW = 45.5 kg + 2.3 kg for each increment of 2.54 cm (1 inch) in length over 152.4 cm (5 feet); ICU, intensive care unit; IQR, interquartile range; LOS, length-of-stay; OR, odds ratio; NA, not applicable; and PVA, patient–ventilator asynchrony
*P < 0.05, compared to patients without PVA
aIncludes myocardial infarction, bleeding gastrointestinal tract, status epilepticus, drug overdose, pulmonary embolism, diabetic ketoacidosis
bDone immediately after first application of the synchrony protocol
cMedication utilization over the course of each patient’s ICU stay. A patient could be on more than one of these medications
dAdjusted for the presence of acute respiratory distress syndrome, use of volume assist-control mode of ventilation and use of dexmedetomidine
eDiscrepancy in numbers between FIO2 and PEEP vs. tidal volume was because the tidal volume values were not recorded on admission for some patients. Discrepancy in numbers between FIO2 and PEEP vs. driving pressure was because plateau pressure was not measured on admission for some patients