Breath Origin in Asynchrony on Mechanical Ventilation

Ventilator asynchrony is a mismatch between the patient’s breathing and the ventilator’s support. It can have various causes and consequences, such as increased work of breathing, respiratory distress, prolonged ventilation, and poor outcomes. One possible cause of ventilator asynchrony is related to the brain origin of the patient’s respiratory drive. For example, reverse triggering is a phenomenon where the ventilator initiates a breath that triggers a reflexive contraction of the diaphragm in brain-dead patients. This can lead to confusion in diagnosing brain death and affect organ donation3. Another example is ineffective triggering, which is a failure to initiate a breath due to an insensitive inspiratory trigger or increased airway resistance. This type of asynchrony is common in brain-injured patients and may be related to their level of consciousness, sedation, or neurologic impairment.