Patient-Ventilator Asynchrony with Dr. Kyle Rehder

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Apr 21, 2025

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INSIGHT

Understanding Patient-Ventilator Asynchrony

Patient-ventilator asynchrony means the patient isn't receiving breaths as they want or how they want them.
This leads to discomfort and potentially lung injury if not addressed properly.

ADVICE

Fixing Missed Trigger Breaths

When an infant has missed triggers, reduce the flow needed to trigger a breath.
Involve a respiratory therapist for troubleshooting and consider NAVA if the problem persists.

ADVICE

Preventing Autotriggering

Avoid setting ventilator sensitivity too low to prevent autotriggering caused by leaks.
Check patient position and cuff inflation; changing the endotracheal tube might be necessary.

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About our Guest:

Kyle Rehder, MD, is a Professor of Pediatrics at Duke University and a pediatric intensivist at Duke Children's Hospital, where he serves as the Vice-Chair of Pediatric Education. He completed his medical school, residency, and chief residency at UNC-Chapel Hill, followed by his fellowship at Duke University. His research is focused on team development and evaluation of advanced respiratory support in the PICU.

Learning Objective:

Develop an expert-based approach to diagnosing and managing common presentations of patient-ventilator asynchrony in the PICU.

References:

Flynn, B. C., Miranda, H. G., Mittel, A. M., & Moitra, V. K. (2022). Stepwise Ventilator Waveform Assessment to Diagnose Pulmonary Pathophysiology. Anesthesiology, 137(1), 85–92. https://doi.org/10.1097/ALN.0000000000004220

Patient-Ventilator Dyssynchrony • LITFL • CCC Ventilation

Citation:

Rehder K, Hodges Z, Shanklin A. Patient-Ventilator Asynchrony. PedsCrit. Online Podcast. 04/2025. https://www.pedscrit.com/patient-ventilator-asynchrony-with-dr-kyle-rehder/

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Thank you for listening to this episode of PedsCrit. Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com. Check out http://www.pedscrit.com for detailed show notes. And visit @critpeds on twitter and @pedscrit on instagram for real time show updates.