The Impact of a Training Intervention on Detection of Patient-Ventilator Asynchronies in Nursing Students: Patient-Ventilator Asynchronies in Nursing Students

The Impact of a Training Intervention on Detection of Patient-Ventilator Asynchronies in Nursing Students

Patient-Ventilator Asynchronies in Nursing Students


  • Francesco Gravante Local Health Autority of Caserta
  • Franco Crisci Local Health Autority of Caserta
  • Luigi Palmieri Corporate Research, Robert Bosch GmbH, Stuttgart (Germany)
  • Luciano Cecere Antonio Cardarelli Hospital, Naples
  • Cristian Fusi EOC Regional Hospital, Lugano (Switzerland)
  • Enrico Bulleri EOC Regional Hospital, Lugano (Switzerland)
  • Luigi Pisani Netherlands & Mahidol Oxford Tropical Medicine Research Unit, Bangkok, (Thailand)
  • Stefano Bambi University of Florence, Florence (Italy)


Nursing student, Patient-Ventilator Asynchronies, Training, Ventilator waveform, asynchrony


Background and aim: Patient-ventilator asynchronies (PVA) are associated to negative outcomes for patients: increased respiratory work, mechanical ventilation time and ICU length of stay, and mortality. Some studies described the positive impact of a training intervention on the knowledge and attitudes of nurses in detecting PVA. The aim of this study was to evaluate the efficacy of a training intervention focused on detection of PVA.

Methods: A before-after design on a single group of nursing students was used. The training intervention about detection of the correct respiratory waveform through graphic monitoring was conducted in a single edition course of 2 hours, for 25 participants. Measurements of correct detection of PVA through specific competency assessment tool were performed before (T0), immediately after (T1) and at 1 month (T2) from the training intervention between January and February 2020.

Results: 19 Nurse students completed the training. A total of 50 questionnaires were distributed (T0; n=19; T1; n=19; T2; n=12). PVA were correctly detected in 67.5% (77) of cases. Statistically significant difference There were differences in trainees performance between T0 and T1 [77,2% (CI95%: 68,7% - 85,8%; p=0.001)] and between T0 and T2 [75% (CI95%: 65,3% - 84,7%; p=0.001]. No significant difference was recorded between T1 and T2 (p=0.83)

Conclusions: Nursing students increased their performance on analysis of the graphic monitoring of the respiratory waveforms and detection of asynchronies after a basic training intervention. These skills were retained after 1 month. Nurse student trained about PVA increased their competence potentially employed in critical care settings.

Author Biographies

Francesco Gravante, Local Health Autority of Caserta

Department of Anesthesia, Intensive Care Unit, Local Health Authority Caserta, Aversa (CE), Italy

Franco Crisci, Local Health Autority of Caserta

Department of Training and Research of Local Health Authority Caserta (Italy);

Luigi Palmieri, Corporate Research, Robert Bosch GmbH, Stuttgart (Germany)

Corporate Research, Robert Bosch GmbH, Stuttgart (Germany)

Luciano Cecere, Antonio Cardarelli Hospital, Naples

Department of Emergency Antonio Cardarelli Hospital, Naples (Italy)

Cristian Fusi, EOC Regional Hospital, Lugano (Switzerland)

Department of Medical & Surgical Intensive Care Unit, EOC Regional Hospital, Lugano (Switzerland);

Enrico Bulleri, EOC Regional Hospital, Lugano (Switzerland)

Department of Medical & Surgical Intensive Care Unit, EOC Regional Hospital, Lugano (Switzerland);

Luigi Pisani, Netherlands & Mahidol Oxford Tropical Medicine Research Unit, Bangkok, (Thailand)

Department of Intensive Care, Academic Medical Center, Amsterdam, Netherlands & Mahidol Oxford Tropical Medicine Research Unit, Bangkok, (Thailand);

Stefano Bambi, University of Florence, Florence (Italy)

Department of Health Sciences, University of Florence, Florence (Italy)


Neto AS, Barbas CSV, Simonis FD, Artigas-Raventós A, Canet J, Determann RM, et al.; PRoVENT; PROVE Network investigators. Epidemiological characteristics, practice of ventilation, and clinical outcome in patients at risk of acute respiratory distress syndrome in intensive care units from 16 countries (PRoVENT): an international, multicentre, prospective study. Lancet Respir Med. 2016;4(11):882-893.

Goligher EC, Ferguson ND, Brochard LJ. Clinical challenges in mechanical ventilation. Lancet. 2016;387(10030):1856-66.

Holanda MA, Vasconcelos RDS, Ferreira JC, Pinheiro BV. Patient-ventilator asynchrony. J Bras Pneumol. 2018;44(4):321-333.

Garofalo E, Bruni A, Pelaia C, Liparota L, Lombardo N, Longhini F, et al. Recognizing, quantifying and managing patient-ventilator asynchrony in invasive and noninvasive ventilation. Expert Rev Respir Med. 2018 Jul;12(7):557-567.

Luo XY, He X, Zhou YM, Wang YM, Chen JR, Chen GQ, et al. Patient-ventilator asynchrony in acute brain-injured patients: a prospective observational study. Ann Intensive Care. 2020;10(1):144.

Mortamet G, Larouche A, Ducharme-Crevier L, Fléchelles O, Constantin G, Essouri S, et al. Patient-ventilator asynchrony during conventional mechanical ventilation in children. Ann Intensive Care. 2017;7(1):122.

Mirabella L, Cinnella G, Costa R, Cortegiani A, Tullo L, Rauseo M, et al. Patient-Ventilator Asynchronies: Clinical Implications and Practical Solutions. Respir Care. 2020;65(11):1751-1766. 7

de Wit M, Miller KB, Green DA, Ostman HE, Gennings C, Epstein SK. Ineffective triggering predicts increased duration of mechanical ventilation. Crit Care Med. 2009;37(10):2740-5.

de Wit M. Monitoring of patient-ventilator interaction at the bedside. Respir Care. 2011 Jan;56(1):61-72. doi: 10.4187/respcare.01077. PMID: 21235839.

Yang LY, Huang YC, Macintyre NR. Patient-ventilator synchrony during pressure-targeted versus flow-targeted small tidal volume assisted ventilation. J Crit Care. 2007;22(3):252-7.

Subirà C, de Haro C, Magrans R, Fernández R, Blanch L. Minimizing Asynchronies in Mechanical Ventilation: Current and Future Trends. Respir Care. 2018;63(4):464-478.

Chao DC, Scheinhorn DJ, Stearn-Hassenpflug M. Patient-ventilator trigger asynchrony in prolonged mechanical ventilation. Chest. 1997;112(6):1592-9.

Imanaka H, Nishimura M, Takeuchi M, Kimball WR, Yahagi N, Kumon K. Autotriggering caused by cardiogenic oscillation during flow-triggered mechanical ventilation. Crit Care Med. 2000;28(2):402-7.

Akoumianaki E, Maggiore SM, Valenza F, Bellani G, Jubran A, Loring SH, et al.; PLUG Working Group (Acute Respiratory Failure Section of the European Society of Intensive Care Medicine). The application of esophageal pressure measurement in patients with respiratory failure. Am J Respir Crit Care Med. 2014;189(5):520-31.

Ferreira JC, Diniz-Silva F, Moriya HT, Alencar AM, Amato MBP, Carvalho CRR. Neurally Adjusted Ventilatory Assist (NAVA) or Pressure Support Ventilation (PSV) during spontaneous breathing trials in critically ill patients: a crossover trial. BMC Pulm Med. 2017;17(1):139.

Du HL, Yamada Y. Expiratory asynchrony. Respir Care Clin N Am. 2005;11(2):265-80.

Parthasarathy S, Jubran A, Tobin MJ. Cycling of inspiratory and expiratory muscle groups with the ventilator in airflow limitation. Am J Respir Crit Care Med. 1998;158(5 Pt 1):1471-8.

Bulleri E, Fusi C, Bambi S, Pisani L. Patient-ventilator asynchronies: types, outcomes and nursing detection skills. Acta Biomed. 2018;89(7-S):6-18.

Nilsestuen JO, Hargett KD. Using ventilator graphics to identify patient-ventilator asynchrony. Respir Care. 2005;50(2):202-34.

Fusi C, Bulleri E, Ricci R. The nurses’ knowledge in the evaluation of the breath asynchronies. Scenario. 2014;31(4):26-30.

Wunsch H. Mechanical Ventilation in COVID-19: Interpreting the Current Epidemiology. Am J Respir Crit Care Med. 2020;202(1):1-4.

Bambi S, Iozzo P, Lucchini A. New Issues in Nursing Management During the COVID-19 Pandemic in Italy. Am J Crit Care. 2020;29(4):e92-e93.

Chacón E, Estruga A, Murias G, Sales B, Montanya J, Lucangelo U, et al. Nurses' detection of ineffective inspiratory efforts during mechanical ventilation. Am J Crit Care. 2012 Jul;21(4):e89-93.

Heidari MR, Norouzadeh R. Nursing students' perspectives on clinical education. J Adv Med Educ Prof. 2015;3(1):39-43.

Bulleri E, Fusi C. Manuale di monitoraggio grafico della ventilazione meccanica. 1st Edition, 2015. Fare Libri.

Chen CW, Lin WC, Hsu CH, Cheng KS, Lo CS. Detecting ineffective triggering in the expiratory phase in mechanically ventilated patients based on airway flow and pressure deflection: feasibility of using a computer algorithm. Crit Care Med. 2008;36(2):455-61.

Di Mussi R, Spadaro S, Volta CA, Bartolomeo N, Trerotoli P, et al. Continuous assessment of neuro-ventilatory drive during 12 h of pressure support ventilation in critically ill patients. Crit Care. 2020;24(1):652.

Wongsurakiat P, Yuangtrakul N. Performance and applications of bedside visual inspection of airway pressure-time curve profiles for estimating stress index in patients with acute respiratory distress syndrome. J Clin Monit Comput. 2019;33(2):281-290.

Ramirez II, Arellano DH, Adasme RS, Landeros JM, Salinas FA, Vargas AG, et al. Ability of ICU Health-Care Professionals to Identify Patient-Ventilator Asynchrony Using Waveform Analysis. Respir Care. 2017;62(2):144-149.

Fleiss JL, Levin B, Paik MC. Statistical Methods for Rates and Proportions. 2003, John Wiley & Sons, Inc.

McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb). 2012;22(3):276-82.

Parenti N, Bacchi Reggiani ML, Sangiorgi D, Serventi V, Sarli L. Effect of a triage course on quality of rating triage codes in a group of university nursing students:a before-after observational study. World J Emerg Med. 2013;4(1):20-5.

Solvik E, Struksnes S. Training Nursing Skills: A Quantitative Study of Nursing Students' Experiences before and after Clinical Practice. Nurs Res Pract. 2018;2018:8984028.

Hagen B, Awosoga O, Kellett P, Dei SO. Evaluation of undergraduate nursing students' attitudes towards statistics courses, before and after a course in applied statistics. Nurse Educ Today. 2013;33(9):949-55.

von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453-7.

von Allmen RS, Weiss S, Tevaearai HT, Kuemmerli C, Tinner C, Carrel TP, Schmidli J, Dick F. Completeness of Follow-Up Determines Validity of Study Findings: Results of a Prospective Repeated Measures Cohort Study. PLoS One. 2015;10(10):e0140817.

Fain J. La ricerca infermieristica, leggerla comprenderla e applicarla. 2004, 2nd Edition, McGraw-Hill.

Polit DF, Beck CT. Ricerca Infermieristica. 2014, McGraw-Hill Education.

Ramírez II, Adasme RS, Arellano DH, Rocha ARM, Andrade FMD, Núñez-Silveira J, et al. Identifying and managing patient-ventilator asynchrony: An international survey. Med Intensiva (Engl Ed). 2021;45(3):138-146.




How to Cite

Gravante F, Crisci F, Palmieri L, Cecere L, Fusi C, Bulleri E, et al. The Impact of a Training Intervention on Detection of Patient-Ventilator Asynchronies in Nursing Students: Patient-Ventilator Asynchronies in Nursing Students. Acta Biomed [Internet]. 2022 May 12 [cited 2024 Jul. 18];93(S2):e2022144. Available from: