A Novel Method to Evaluate Patient-Ventilator Synchrony during Mechanical Ventilation

<div>Four phases of a breathing cycle. a: <span class="nowrap"><svg height="13.3017pt" id="M58" style="vertical-align:-5.48788pt" version="1.1" viewbox="-0.0498162 -7.81382 30.1191 13.3017" width="30.1191pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.013,0,0,-0.013,0,0)"><path d="M324 430H196L233 583L223 592L145 529L120 430H54L29 396L31 388H111L56 126C33 15 54 -12 77 -12C137 -12 214 57 250 95L233 119C208 92 155 59 138 59C126 59 120 70 131 125L186 390L298 394L324 430Z"></path></g><g transform="matrix(.0091,0,0,-0.0091,4.368,3.132)"><path d="M303 37L293 66C280 59 256 49 231 49S173 63 173 143V396H281C294 404 298 428 287 439H173V575L158 577L92 509V439H46L17 408L22 396H92V107C92 27 128 -12 192 -12C203 -12 218 -9 237 2L303 37Z"></path></g><g transform="matrix(.0091,0,0,-0.0091,7.262,3.132)"><path d="M185 344V453C137 433 92 421 41 413V386C100 378 104 375 104 310V106C104 41 97 35 33 30V0H268V30C190 35 185 41 185 107V283C206 340 240 371 267 371C282 371 296 364 310 351C316 344 325 343 336 348C357 357 369 378 369 399C369 424 345 451 310 451C262 451 219 397 187 344H185Z"></path></g><g transform="matrix(.0091,0,0,-0.0091,10.784,3.132)"><path d="M138 535C169 535 191 560 191 589C191 620 168 644 139 644S85 620 85 589C85 560 110 535 138 535ZM257 0V30C192 35 185 43 185 109V453C142 435 94 422 40 414V386C101 378 104 372 104 311V109C104 41 97 35 33 30V0H257Z"></path></g><g transform="matrix(.0091,0,0,-0.0091,13.286,3.132)"><path d="M472 439C432 432 382 428 334 425C303 442 271 451 236 451H235C158 451 54 398 54 285C54 216 97 171 140 152C124 133 93 105 53 90C52 81 55 63 64 48C77 27 102 5 137 -6C115 -22 77 -53 57 -73C40 -88 32 -107 32 -130C32 -189 96 -253 208 -253C340 -253 461 -159 461 -56C461 44 378 63 314 63C281 63 246 62 207 62C163 62 145 80 145 99C145 114 160 130 175 141C191 138 210 136 226 136C314 136 405 188 405 294C405 329 393 359 376 382L433 378C448 387 469 415 477 430L472 439ZM226 417C282 417 320 364 320 288S281 172 236 171C180 171 142 224 142 300S182 417 226 417ZM248 -9C291 -9 319 -11 346 -22S390 -57 390 -90C390 -151 339 -199 246 -199C171 -199 114 -159 114 -106C114 -79 132 -53 159 -30C178 -15 200 -9 248 -9Z"></path></g><g transform="matrix(.0091,0,0,-0.0091,17.709,3.132)"><path d="M472 439C432 432 382 428 334 425C303 442 271 451 236 451H235C158 451 54 398 54 285C54 216 97 171 140 152C124 133 93 105 53 90C52 81 55 63 64 48C77 27 102 5 137 -6C115 -22 77 -53 57 -73C40 -88 32 -107 32 -130C32 -189 96 -253 208 -253C340 -253 461 -159 461 -56C461 44 378 63 314 63C281 63 246 62 207 62C163 62 145 80 145 99C145 114 160 130 175 141C191 138 210 136 226 136C314 136 405 188 405 294C405 329 393 359 376 382L433 378C448 387 469 415 477 430L472 439ZM226 417C282 417 320 364 320 288S281 172 236 171C180 171 142 224 142 300S182 417 226 417ZM248 -9C291 -9 319 -11 346 -22S390 -57 390 -90C390 -151 339 -199 246 -199C171 -199 114 -159 114 -106C114 -79 132 -53 159 -30C178 -15 200 -9 248 -9Z"></path></g><g transform="matrix(.0091,0,0,-0.0091,22.004,3.132)"><path d="M384 109C349 76 310 59 268 59C197 59 123 113 120 245C240 248 367 259 384 262C403 266 407 275 407 296C407 376 338 451 254 451H253C201 451 148 425 105 378C65 334 39 272 39 203C39 88 112 -12 235 -12C266 -12 339 5 402 84L384 109ZM230 411C285 411 319 365 319 313C319 298 313 293 294 293C236 291 180 290 125 290C141 370 185 411 230 411Z"></path></g><g transform="matrix(.0091,0,0,-0.0091,25.954,3.132)"><path d="M185 344V453C137 433 92 421 41 413V386C100 378 104 375 104 310V106C104 41 97 35 33 30V0H268V30C190 35 185 41 185 107V283C206 340 240 371 267 371C282 371 296 364 310 351C316 344 325 343 336 348C357 357 369 378 369 399C369 424 345 451 310 451C262 451 219 397 187 344H185Z"></path></g></svg>,</span> the trigger time; b: <span class="nowrap"><svg height="11.1095pt" id="M59" style="vertical-align:-3.29568pt" version="1.1" viewbox="-0.0498162 -7.81382 18.4732 11.1095" width="18.4732pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.013,0,0,-0.013,0,0)"><path d="M324 430H196L233 583L223 592L145 529L120 430H54L29 396L31 388H111L56 126C33 15 54 -12 77 -12C137 -12 214 57 250 95L233 119C208 92 155 59 138 59C126 59 120 70 131 125L186 390L298 394L324 430Z"></path></g><g transform="matrix(.0091,0,0,-0.0091,4.368,3.132)"><path d="M185 344V453C137 433 92 421 41 413V386C100 378 104 375 104 310V106C104 41 97 35 33 30V0H268V30C190 35 185 41 185 107V283C206 340 240 371 267 371C282 371 296 364 310 351C316 344 325 343 336 348C357 357 369 378 369 399C369 424 345 451 310 451C262 451 219 397 187 344H185Z"></path></g><g transform="matrix(.0091,0,0,-0.0091,7.89,3.132)"><path d="M138 535C169 535 191 560 191 589C191 620 168 644 139 644S85 620 85 589C85 560 110 535 138 535ZM257 0V30C192 35 185 43 185 109V453C142 435 94 422 40 414V386C101 378 104 372 104 311V109C104 41 97 35 33 30V0H257Z"></path></g><g transform="matrix(.0091,0,0,-0.0091,10.365,3.132)"><path d="M327 325C324 350 312 408 304 433C283 442 256 451 213 451C120 451 59 391 59 320C59 243 125 210 188 181C237 158 266 136 266 93C266 52 231 24 195 24C134 24 93 81 74 148L42 143C42 106 51 37 59 23C78 8 125 -12 177 -12C257 -12 345 35 345 127C345 198 292 234 216 264C171 283 131 305 131 348C131 387 156 416 195 416C243 416 277 378 297 317L327 325Z"></path></g><g transform="matrix(.0091,0,0,-0.0091,13.86,3.132)"><path d="M384 109C349 76 310 59 268 59C197 59 123 113 120 245C240 248 367 259 384 262C403 266 407 275 407 296C407 376 338 451 254 451H253C201 451 148 425 105 378C65 334 39 272 39 203C39 88 112 -12 235 -12C266 -12 339 5 402 84L384 109ZM230 411C285 411 319 365 319 313C319 298 313 293 294 293C236 291 180 290 125 290C141 370 185 411 230 411Z"></path></g></svg>,</span> the rise time; c: <span class="nowrap"><svg height="11.1095pt" id="M60" style="vertical-align:-3.29568pt" version="1.1" viewbox="-0.0498162 -7.81382 15.2214 11.1095" width="15.2214pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.013,0,0,-0.013,0,0)"><path d="M324 430H196L233 583L223 592L145 529L120 430H54L29 396L31 388H111L56 126C33 15 54 -12 77 -12C137 -12 214 57 250 95L233 119C208 92 155 59 138 59C126 59 120 70 131 125L186 390L298 394L324 430Z"></path></g><g transform="matrix(.0091,0,0,-0.0091,4.368,3.132)"><path d="M303 37L293 66C280 59 256 49 231 49S173 63 173 143V396H281C294 404 298 428 287 439H173V575L158 577L92 509V439H46L17 408L22 396H92V107C92 27 128 -12 192 -12C203 -12 218 -9 237 2L303 37Z"></path></g><g transform="matrix(.0091,0,0,-0.0091,7.162,3.132)"><path d="M384 109C349 76 310 59 268 59C197 59 123 113 120 245C240 248 367 259 384 262C403 266 407 275 407 296C407 376 338 451 254 451H253C201 451 148 425 105 378C65 334 39 272 39 203C39 88 112 -12 235 -12C266 -12 339 5 402 84L384 109ZM230 411C285 411 319 365 319 313C319 298 313 293 294 293C236 291 180 290 125 290C141 370 185 411 230 411Z"></path></g><g transform="matrix(.0091,0,0,-0.0091,11.111,3.132)"><path d="M185 344V453C137 433 92 421 41 413V386C100 378 104 375 104 310V106C104 41 97 35 33 30V0H268V30C190 35 185 41 185 107V283C206 340 240 371 267 371C282 371 296 364 310 351C316 344 325 343 336 348C357 357 369 378 369 399C369 424 345 451 310 451C262 451 219 397 187 344H185Z"></path></g></svg>,</span> the termination of inhalation; d: <span class="nowrap"><svg height="14.45pt" id="M61" style="vertical-align:-5.48788pt" version="1.1" viewbox="-0.0498162 -8.96212 26.5163 14.45" width="26.5163pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.013,0,0,-0.013,0,0)"><path d="M620 675H597C578 656 570 650 541 650H144C112 650 104 653 94 675H72C59 618 42 552 23 493L53 491C71 534 88 564 105 585C124 608 144 615 238 615H290L197 121C182 40 174 34 88 28L82 0H361L367 28C275 34 266 38 281 121L374 615H441C522 615 543 608 553 583C562 560 566 531 565 493L597 494C603 551 612 629 620 675Z"></path></g><g transform="matrix(.0091,0,0,-0.0091,7.176,3.132)"><path d="M396 114C349 71 317 59 274 59C216 59 123 104 123 241C123 342 180 400 246 400C283 400 317 386 348 359C355 352 361 348 366 348C378 348 401 371 402 394C402 405 398 413 385 424C369 437 337 451 294 451H293C254 451 193 434 141 394C73 342 39 277 39 198C39 90 114 -12 243 -12C303 -12 371 31 415 90L396 114Z"></path></g><g transform="matrix(.0091,0,0,-0.0091,11.253,3.132)"><path d="M488 439H302V409C359 401 366 390 354 354C333 287 289 177 262 107L171 356C158 391 163 402 210 409L209 439H3V409C59 401 68 388 90 336C119 267 164 144 204 31C211 16 211 0 206 -15C202 -27 195 -48 176 -81C153 -124 134 -146 102 -166C85 -177 77 -187 77 -203C77 -228 107 -253 136 -253C151 -253 164 -248 169 -228C185 -175 203 -120 273 41C342 204 375 284 399 337C425 392 435 401 488 409V439Z"></path></g><g transform="matrix(.0091,0,0,-0.0091,15.622,3.132)"><path d="M396 114C349 71 317 59 274 59C216 59 123 104 123 241C123 342 180 400 246 400C283 400 317 386 348 359C355 352 361 348 366 348C378 348 401 371 402 394C402 405 398 413 385 424C369 437 337 451 294 451H293C254 451 193 434 141 394C73 342 39 277 39 198C39 90 114 -12 243 -12C303 -12 371 31 415 90L396 114Z"></path></g><g transform="matrix(.0091,0,0,-0.0091,19.507,3.132)"><path d="M244 0V30C178 35 170 41 170 107V710C136 697 72 680 18 675V647C83 642 89 639 89 572V107C89 43 80 35 16 30V0H244Z"></path></g><g transform="matrix(.0091,0,0,-0.0091,21.873,3.132)"><path d="M384 109C349 76 310 59 268 59C197 59 123 113 120 245C240 248 367 259 384 262C403 266 407 275 407 296C407 376 338 451 254 451H253C201 451 148 425 105 378C65 334 39 272 39 203C39 88 112 -12 235 -12C266 -12 339 5 402 84L384 109ZM230 411C285 411 319 365 319 313C319 298 313 293 294 293C236 291 180 290 125 290C141 370 185 411 230 411Z"></path></g></svg>,</span> the termination of a breathing cycle; e: <span class="nowrap"><svg height="11.1095pt" id="M62" style="vertical-align:-3.29568pt" version="1.1" viewbox="-0.0498162 -7.81382 36.6499 11.1095" width="36.6499pt" xmlns="http://www.w3.org/2000/svg" xmlns:xlink="http://www.w3.org/1999/xlink"><g transform="matrix(.013,0,0,-0.013,0,0)"><path d="M324 430H196L233 583L223 592L145 529L120 430H54L29 396L31 388H111L56 126C33 15 54 -12 77 -12C137 -12 214 57 250 95L233 119C208 92 155 59 138 59C126 59 120 70 131 125L186 390L298 394L324 430Z"></path></g><g transform="matrix(.0091,0,0,-0.0091,4.368,3.132)"><path d="M384 109C349 76 310 59 268 59C197 59 123 113 120 245C240 248 367 259 384 262C403 266 407 275 407 296C407 376 338 451 254 451H253C201 451 148 425 105 378C65 334 39 272 39 203C39 88 112 -12 235 -12C266 -12 339 5 402 84L384 109ZM230 411C285 411 319 365 319 313C319 298 313 293 294 293C236 291 180 290 125 290C141 370 185 411 230 411Z"></path></g><g transform="matrix(.0091,0,0,-0.0091,8.317,3.132)"><path d="M100 439H52L25 408L28 396H100V106C100 41 92 35 31 30V0H250V29C188 37 181 41 181 106V396H372V107C372 40 365 37 309 29V0H537V29C461 37 453 40 453 106V396H564C576 403 579 428 574 439H453V469C452 558 462 604 474 623S500 656 527 656C562 656 589 634 608 615C619 604 628 607 639 615C647 622 658 633 661 641C666 653 664 664 656 674C637 696 609 708 572 710C528 703 483 682 439 638C418 661 380 685 320 688C269 683 230 666 190 633C139 593 122 550 113 525S100 476 100 451V439ZM372 439H181V461C181 530 194 571 211 598C226 621 248 643 287 643C343 643 379 607 400 578C391 561 384 546 381 529C376 510 372 486 372 457V439Z"></path></g><g transform="matrix(.0091,0,0,-0.0091,14.281,3.132)"><path d="M384 109C349 76 310 59 268 59C197 59 123 113 120 245C240 248 367 259 384 262C403 266 407 275 407 296C407 376 338 451 254 451H253C201 451 148 425 105 378C65 334 39 272 39 203C39 88 112 -12 235 -12C266 -12 339 5 402 84L384 109ZM230 411C285 411 319 365 319 313C319 298 313 293 294 293C236 291 180 290 125 290C141 370 185 411 230 411Z"></path></g><g transform="matrix(.0091,0,0,-0.0091,18.276,3.132)"><path d="M396 114C349 71 317 59 274 59C216 59 123 104 123 241C123 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212 127L243 284L314 263C327 263 339 263 352 264C465 271 600 337 600 480ZM508 481C508 351 402 304 329 304C289 304 265 311 250 317L295 559C302 594 310 606 323 611C335 616 350 619 367 619C455 619 508 573 508 481Z"></path></g><g transform="matrix(.0091,0,0,-0.0091,6.656,3.132)"><path d="M46 650V618C122 613 130 611 130 522V128C130 46 123 40 40 32V0H319V32C227 40 217 42 217 128V279L292 260C303 259 322 258 338 261C436 272 534 337 534 467C534 534 508 580 469 609C428 640 371 650 299 650H46ZM217 558C217 585 220 596 228 603C235 610 256 615 284 615C367 615 435 571 435 463C435 339 358 304 291 304C256 304 229 310 217 317V558Z"></path></g><g transform="matrix(.0091,0,0,-0.0091,11.87,3.132)"><path d="M416 501L399 642C356 655 314 665 271 665C140 665 63 582 63 486C63 372 163 325 229 290C304 250 359 217 359 142C359 70 316 25 240 25C138 25 94 125 78 186L44 178C52 123 64 45 72 21C81 16 96 8 121 0S179 -15 220 -15C353 -15 445 68 445 176C445 289 350 335 270 375C191 414 143 449 143 520C143 572 177 627 253 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Complexity

fig13

Figure 13

Figure 13: A Novel Method to Evaluate Patient-Ventilator Synchrony during Mechanical Ventilation 