Patient-ventilator interaction in mechanically ventilated children

Mechanical ventilation is a life-saving intervention in severe medical situations and a cornerstone in the management of critically ill children. To ensure efficiency of mechanical ventilation, ventilator performance should meticulously match the patients demands. This requires an optimal synchronization between the patient and the ventilator. Patient-ventilator asynchrony develops if patient and ventilator are out-of-sync. The studies reported in this thesis were performed for a better understanding of the occurrence and clinical implications of patient-ventilator asynchrony in critically ill children as unique developmental aspects between children and adults making it difficult to translate findings from studies performed in adults to children and so far adult-based definitions are used to characterize patient-ventilator asynchrony in children. For example, whereas in adults, patient-ventilator asynchrony is associated with prolonged duration of mechanical ventilation, increased intensive care unit stay and increased mortality, we could not confirm this in children. In contrast, mechanically ventilated children with a high level of patient-ventilator asynchrony had a shorter duration of mechanical ventilation. Although we could not ascertain an effect on the duration of mechanical ventilation, patient-ventilator asynchrony in mechanically ventilated children cannot be ignored. We found that patient-ventilator asynchrony can increase the work-of-breathing by 30-40%. To further study the effects of patient-ventilator asynchrony continuous monitoring systems are needed. In this thesis we designed and validated such a tool. The first step to truly understand the ramifications of patient-ventilator asynchrony on clinical outcome.