Patient-Ventilator Dyssynchrony: Clinical Significance and Implications for Practice

Mellott, Karen G.; Grap, Mary Jo; Munro, Cindy L.; Sessler, Curtis N.; Wetzel, Paul A.

doi:10.4037/ccn2009612

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Features| December 01 2009

Patient-Ventilator Dyssynchrony: Clinical Significance and Implications for Practice

Karen G. Mellott, RN, MS;

Karen G. Mellott, RN, MS

Karen G. Mellott is a doctoral candidate and a National Institute for Nursing Research pre-doctoral fellow in the School of Nursing at Virginia Commonwealth University in Richmond. Her research focuses on patient-ventilator dyssynchrony and the patient/technology interface.

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Mary Jo Grap, RN, PhD, ACNP;

Mary Jo Grap, RN, PhD, ACNP

Mary Jo Grap is a professor in the School of Nursing at Virginia Commonwealth University. She is an expert nurse researcher in mechanical ventilation and critical care nursing.

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Cindy L. Munro, RN, PhD, ANP-C;

Cindy L. Munro, RN, PhD, ANP-C

Cindy L. Munro is a professor in the School of Nursing at Virginia Commonwealth University and volunteers as an adult nurse practitioner at Petersburg Health Care Alliance in Virginia. Her research examines the impact of oral health on the general health of patients and the care of patients receiving mechanical ventilation. She is also the coeditor of the American Journal of Critical Care.

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Curtis N. Sessler, MD;

Curtis N. Sessler, MD

Curtis N. Sessler is the Orhan Muren Professor of Medicine at Virginia Commonwealth University. His current research interests are sepsis and multiorgan failure, prevention of nosocomial infection, and agitation and sedation in intensive care patients.

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Paul A. Wetzel, PhD

Paul A. Wetzel is an associate professor in the School of Engineering, department of biomedical engineering at Virginia Commonwealth University. His primary research emphasis is on development of human-machine interfaces on the basis of eye movement and visual analysis.

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Crit Care Nurse (2009) 29 (6): 41–55.

https://doi.org/10.4037/ccn2009612

Nurses continue to face the challenge of preventing the consequences of patient-ventilator dyssynchrony, which is common yet underappreciated in critically ill patients.

The cost of providing care to critically ill patients in the United States consumes roughly 15% of all health care dollars, or 1% of the gross national product.¹ Contributing to this economic burden are patients admitted to the intensive care unit (ICU) who require mechanical ventilation and patients with complications from their dependence on this technology.²^,³ In fact, 50% of ICU patients receive mechanical ventilation.⁴

Often, sedation is required to increase patients’ tolerance of the endotracheal tube, reduce anxiety, and facilitate sleep. In particular, sedation is used frequently to reduce patient-ventilator dyssynchrony (PVD).⁵^,^–⁹ Sassoon and Foster¹⁰ define PVD as a mismatching between the patient’s breaths (neural) and ventilator-assisted breaths (phase asynchrony), as well as the inability of the...

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