Asynchrony and cyclic variability in pressure support noninvasive ventilation

Noninvasive mechanical ventilation is an effective procedure to manage patients with acute or chronic respiratory failure. Most ventilators act as flow generators that assist spontaneous respiratory cycles by delivering inspiratory and expiratory pressures. This allows the patient to improve alveolar ventilation and subsequent pulmonary gas exchanges. The interaction between the patient and his ventilator are therefore crucial for tolerance and acceptability and part of this interaction is the facility to trigger the ventilator at the beginning of the inspiration. This is directly related to patients' discomfort which is not quantified today. Phase portraits reconstructed from the airflow and first-return maps built on the total breath duration were used to investigate the quality of the patient-ventilator interaction. Phase synchronization can be identified from phase portrait and the breath-to-breath variability is well characterized by return maps. This paper is a first step in the direction of automatically estimating the comfort from measurements and not from a necessarily subjective answer given by the patient. These tools could be helpful for the physicians to set the ventilator parameters. (C) 2007 Elsevier Ltd. All rights reserved.