Ventilatory asynchronies induced by routine clinical practices in the intensive care unit: A systematic observation combined with a scoping review.

Background: Patient-ventilator asynchronies (PVAs) are common during mechanical ventilation and are associated with adverse outcomes. While most research has focused on ventilator modes, pulmonary mechanics, and sedation, the influence of routine clinical practices remains largely unexplored. Objectives: To document ventilatory asynchronies induced by routine clinical practices through systematic observation and to contrast these findings with a structured scoping review of the literature. Methods: Systematic observation of ventilator waveforms was performed during routine clinical interventions in critically ill patients receiving invasive mechanical ventilation. In parallel, a scoping review was conducted across five databases (Scopus, ScienceDirect, PubMed, LILACS, and Cochrane), guided by the PCC framework (Population, Concept, and Context) and PRISMA-ScR recommendations. Study selection was carried out independently by two reviewers using Rayyan software, with disagreements resolved by consensus. Results: Thirteen studies were included in the scoping review; only three addressed the eight PVAs described in the literature, and none reported induced asynchronies as a cause or risk factor. Our observational analysis demonstrated that routine interventions such as respiratory care, repositioning, and intrahospital transfers may trigger transient episodes of PVA. Conclusions: Routine clinical practices,including suctioning, repositioning, and intrahospital transport, can unintentionally induce PVAs. To the best of our knowledge, this phenomenon has not previously been reported in the literature, as confirmed by our scoping review. These findings highlight an overlooked source of asynchrony with potential clinical implications.