Patient-Ventilator Interaction and Discordance

Educational reference — a way to name and measure what happens when a patient and a ventilator breathe together. It is not a bedside directive or a substitute for a device’s operator’s manual or for clinical judgment.

What “interaction” actually means

Watch a spontaneously breathing patient on a ventilator for one breath and you are watching a negotiation. Two pressures push on the same respiratory system at the same time: the ventilator’s applied pressure, Pvent, and the patient’s own muscular effort, Pmus. They add together to move air, and the Equation of Motion for the Respiratory System is the ledger that keeps the accounts:

Pvent(t) + Pmus(t) = E·V(t) + R·V̇(t)

The two pressure sources on the left must jointly overcome the elastic load (E·V) and the resistive load (R·V̇) to produce flow and volume [Mireles-Cabodevila 2026 · PVI]. Every assisted breath is therefore an interaction — a moment-to-moment apportioning of force between machine and patient — and that force balance is the single fact from which the whole subject is read [Mireles-Cabodevila 2026 · PVI].

This connects directly to the companion chapter on modes. Choosing a mode pre-declares, in advance, how the machine intends to divide the work and share the timing across each breath — which is why the 2022 flagship paper builds a taxonomy of interactions on the same equation-of-motion footing as the taxonomy of modes [Mireles-Cabodevila 2022]. Describing a mode and describing patient–ventilator interaction (PVI) are thus two views of one relationship — one written before the breath, the other read off the breath as it happens. See The Taxonomy of Ventilator Modes for the “before” view; this chapter is the “during” view.

The one idea to carry through: PVI is the real-time relationship between Pmus and Pvent, and everything that follows — synchrony, discordance, work shifting, measurement — is just a disciplined way of describing that relationship along two axes, timing and magnitude [Mireles-Cabodevila 2026 · PVI].

The historical problem: many words, no vocabulary

For decades the field had plenty of words for interaction gone wrong and no agreed meaning for any of them. The literature drew its terms from incompatible bases — etiology (“reverse trigger”), outcome (“breath-stacking”), pattern (“double trigger”), or vague description (“flow asynchrony”) — so the same waveform picked up several names and the same name covered several phenomena [Mireles-Cabodevila 2022]. A 2020 year-in-review of synchrony research diagnosed the root cause plainly: this type of research lacks a standardized vocabulary and associated taxonomy, which makes it hard for students and researchers even to communicate, let alone compare results [Chatburn 2020 · Year in Review]. An accompanying editorial put the demand in its title — we need consensus on classifying and quantifying interactions [Mireles-Cabodevila 2022 · Consensus] (a metadata-only artifact in this corpus, so cited only for that title-level thesis) [open].

Historically the problem was invisible because interaction was recognized only in the extreme — the patient “fighting” or “bucking” the ventilator, obvious from diaphoresis and accessory-muscle use. Early clinicians even read flow starvation off the “double-clutching” of an aneroid manometer needle: pressure rising at breath onset, the needle dipping below PEEP, then a high peak [Branson & Chatburn 2026]. Modern pressure, flow, and volume displays reveal far subtler mismatches — and in doing so revealed that interaction problems are common and routinely missed at the bedside [Branson & Chatburn 2026]. This is the same disease the mode taxonomy cured for mode names, now diagnosed for interaction: too many labels, no shared grammar.

The proposed fix: a taxonomy for interaction, stated as ten maxims

flowchart TD
  PVI["Patient–ventilator interaction"] --> T["Timing axis"]
  PVI --> Mg["Magnitude axis<br/>(work shifting)"]
  T --> Tr["Trigger discordance<br/>late · early · false · failed"]
  T --> Cy["Cycle discordance<br/>short/premature · delayed/late"]
  Mg --> U["under-assist<br/>(e.g. flow starvation)"]
  Mg --> Ga["goal-appropriate"]
  Mg --> Ov["over-assist"]

Figure 1 — the two axes of patient–ventilator interaction and the named discordances along each. Adapted from [Mireles-Cabodevila 2026 · PVI] and [Branson & Chatburn 2026].

The remedy arrived in two steps. The 2022 paper proposed a standardized nomenclature and taxonomy for patient–ventilator interactions, together with a systematic method to read the waveforms that carry the evidence of interaction [Mireles-Cabodevila 2022]. The 2026 paper extended it from defining interaction to measuring it, and stated the whole thing as ten fundamental maxims — a small set of first-principles rules from which a formal taxonomy and a basis for measurement can be built [Mireles-Cabodevila 2026 · PVI]. Like the mode taxonomy, this is offered as a [proposed] standard: the authors advocate it and acknowledge that the terms are not yet agreed and that consensus is still needed [Mireles-Cabodevila 2026 · PVI].

A companion, not a version. These ten PVI maxims are deliberately modeled on the 2014 mode-taxonomy “ten fundamental maxims” — the paper says, in effect, “as we have done when developing the taxonomy for modes of mechanical ventilation, we propose 10 maxims,” and cites the 2014 work as its reference [Mireles-Cabodevila 2026 · PVI]. The two share the same rhetorical device, the same first-principles foundation (the equation of motion), and the same two-part taxonomy structure (a standardized vocabulary plus a hierarchical organization) — but they cover distinct subjects. The 2014 maxims classify modes; the 2026 maxims classify interaction. Crucially, the newer set does not supersede the older one. PVI is layered on top of the mode taxonomy — the PVI paper reuses mode vocabulary throughout (trigger/cycle attribution, mode tags like PC-CMVs) — so the two “ten maxims” works are companions, not competitors [Mireles-Cabodevila 2026 · PVI]. They are not the same ten rules; do not conflate them. See The Taxonomy of Ventilator Modes for the mode set.

Grouped, the PVI maxims are the scaffold for the rest of this chapter, all resting on the equation of motion [Mireles-Cabodevila 2026 · PVI]:

• Foundations (1–2). Every interaction derives from the EoM force balance (Maxim 1), and patient effort, Pmus, is the reference signal against which interaction is judged (Maxim 2).
• The two axes (3). Interaction is defined along timing (phase difference between Pmus and Pvent) and magnitude (the work balance, or “work shifting”).
• Timing (4–6). Synchrony is a zero phase difference (Maxim 4); out-of-phase signals define timing discordance (Maxim 5); and missing signals — one present without the other — define false and failed triggering (Maxim 6).
• Magnitude (7–9). Three inspiratory states — unassisted, passive assisted, active assisted (Maxim 7); work is shared in active assisted breaths, the “work shifting” (Maxim 8); and assistance is a continuum from over- to under-assistance set by how much work is shifted (Maxim 9).
• Expiration (10). Four expiratory states — passive, active, assisted, and controlled.

Axis 1 — timing, and the reference signal problem

The timing axis asks a simple question with an awkward answer: does the ventilator start and stop in phase with the patient’s effort? Support should begin when the patient wants to inhale and end when the patient wants to exhale [Mireles-Cabodevila 2026 · PVI]. Synchrony is the ideal — a zero phase difference (Δt = 0) between the patient effort signal Pmus(t) and the ventilator response Pvent(t) [Mireles-Cabodevila 2026 · PVI]. Because the two waveforms have different shapes (a smooth Pmus versus a squared-off PC or VC Pvent), synchrony is judged not as whole-curve overlap but at three reference points — trigger (onset of inspiration), cycle (end of inspiration), and peak (the maximum, largely a research parameter) — each measured against the corresponding patient event [Mireles-Cabodevila 2026 · PVI].

The awkward part is the reference signal itself. Interaction is defined against Pmus, but Pmus cannot be measured directly; it is estimated by surrogates, each with technical limits and a time lag relative to true effort [Mireles-Cabodevila 2026 · PVI]:

• electrical activity of the diaphragm or respiratory muscles (EAdi / EMG);
• esophageal pressure (Pes) via balloon catheter — the practical bedside standard;
• thoracic–abdominal motion via respiratory inductance plethysmography (RIP) belts;
• and, when no dedicated monitor is present, the airway flow and pressure waveforms on the ventilator, from which Pmus is inferred [Mireles-Cabodevila 2022; Mireles-Cabodevila 2026 · PVI].

The currently accepted standard — a full Pmus waveform — is impractical to obtain clinically and challenging even in research [Mireles-Cabodevila 2026 · PVI]. The mechanics of obtaining these surrogates belong to Bedside Monitoring of Respiratory Mechanics; the point here is that timing is always measured against a signal we can only approximate.

Naming the mismatch: discordance, asynchrony, dyssynchrony

Before cataloguing the failures, the corpus separates three words that the older literature used interchangeably [Mireles-Cabodevila 2026 · PVI]:

• Asynchrony (a- not + syn together + chronos time): a lack of alignment in time — a neutral descriptor, and timing only.
• Dyssynchrony (dys- bad/poor): also timing only, but carrying an inherently negative connotation that is problematic when the clinical importance is uncertain.
• Discordance (Latin discordare, “to disagree”): this group’s umbrella term, covering all mismatches between patient-derived and ventilator-derived signals — both timing and magnitude. The authors are candid that “discordance” has not been widely adopted, and retain the legacy words for continuity while flagging their limits [Mireles-Cabodevila 2026 · PVI].

So in this framework discordance is the whole (timing + magnitude), while asynchrony and dyssynchrony are the timing-only slice [proposed]. A second design choice runs through every term below: the preferred names are descriptive and signal-based (“early,” “late,” “failed”) rather than etiologic, chosen deliberately so a name describes what the tracing shows and stays valid as new causes are discovered [Mireles-Cabodevila 2022]. Each preferred term therefore deprecates a cluster of legacy synonyms — the tables below list them.

Timing discordance in detail

Timing discordance is a mismatch between the patient’s neural breath timing and the ventilator’s timing, and it is classified by breath phase into trigger events (the start) and cycle events (the end) [Branson & Chatburn 2026]. With concordance a modern ICU ventilator responds fast — trigger delay is typically < 80 ms on the bench, below the ~120 ms at which a patient begins to sense a lag — so on a well-set modern device, discomfort from timing alone is unlikely [Branson & Chatburn 2026].

Trigger-phase discordances

Preferred term	What the tracing shows	Deprecated legacy terms
Late trigger	Ventilator responds after a clinically important delay; evidence of Pmus (a baseline pressure dip or flow rise) appears well before inspiratory flow starts. Causes: insensitive trigger, air-trapping, slow portable devices.	trigger delay, late inflation
Early trigger	A machine-triggered breath precedes the patient’s effort, which then arrives later in inspiration. Reverse triggering is one cause (via respiratory entrainment), not the name of the event.	reverse trigger, early inflation
False trigger	A non-Pmus signal starts the breath — circuit condensate/secretions, leaks, algorithm “ringing,” or cardiogenic oscillations (classically with normal compliance and a bounding pulse). No patient effort is present.	auto trigger, auto cycling
Failed trigger	A patient effort that fails to trigger a breath: a positive deflection in the expiratory-flow waveform that does not cross zero. Most common with auto-PEEP in obstructive disease and with over-assistance.	ineffective triggering, ineffective effort, missed trigger, wasted efforts

[Branson & Chatburn 2026; Mireles-Cabodevila 2022]

Two of these repay a closer look. Early trigger is the deliberate rename of what was called reverse triggering: the authors prefer “early trigger” because it names the signal pattern — a machine breath followed by evidence of effort — while reverse triggering is merely one mechanism behind that pattern [Branson & Chatburn 2026]. It is most prevalent during low-tidal-volume ventilation and during emergence from sedation, where it can appear in up to roughly half of patients, and it comes in three timing phenotypes (early, mid-cycle, and late reverse trigger; the mid-cycle form is the most common and deforms early expiratory flow) [Branson & Chatburn 2026].

Failed trigger carries a naming argument worth preserving: the authors object to “missed trigger” because nothing was missed — the effort genuinely happened, the ventilator simply did not respond — and prefer “failed trigger effort” [Branson & Chatburn 2026]. It matters clinically because it is among the timing events most strongly linked to worse outcomes, alongside clusters of events [Branson & Chatburn 2026].

Under the maxims, false and failed triggering are a special category: “missing signals,” where one of Pvent or Pmus is present without the other, so no phase difference Δt can even be computed [Mireles-Cabodevila 2026 · PVI]. They are mismatches of presence, not of phase.

The three trigger discordances below are drawn against the reference signal Pmus (bottom trace); the ventilator breaths are computed from the equation of motion and the patient effort is added schematically to show its timing signature.

Figure 2 — failed trigger (preferred over “ineffective triggering”). A real patient effort is too weak to cross the trigger threshold: it leaves a small dip in airway pressure and a positive deflection interrupting the expiratory-flow decay, but no breath follows. Most common with auto-PEEP and with over-assistance. Original schematic; signatures per [Branson & Chatburn 2026] and [Mireles-Cabodevila 2022].

Figure 3 — false trigger (preferred over “auto trigger”). A non-Pmus signal — circuit condensate, a leak, algorithm “ringing,” or cardiogenic oscillations — starts a breath with no patient effort at all (the Pmus trace is flat). Original schematic; signatures per [Branson & Chatburn 2026] and [Mireles-Cabodevila 2022].

Figure 4 — early trigger (the descriptive rename; reverse triggering is one cause, via respiratory entrainment). A machine-triggered breath fires first, and the patient’s effort appears only after insufflation has started — the reverse of normal order. Original schematic; framing per [Branson & Chatburn 2026].

Cycle-phase discordances

Cycle discordance is a mismatch at end-inspiration, most common during pressure support [Branson & Chatburn 2026]:

Preferred term	What the tracing shows	Deprecated legacy terms
Early cycle	Inspiration ends before the Pmus peak — the patient’s neural inspiratory time exceeds the ventilator’s. From too-short set inspiratory time (mandatory breaths) or too-high flow-cycle threshold (pressure support).	premature cycling, premature termination, short cycling
Late cycle	The ventilator’s inspiratory time exceeds the patient’s neural inspiratory time. From an inappropriate inspiratory-time or flow-termination setting, or from a leak that keeps inspiratory flow above the cycle threshold.	prolonged cycling, delayed cycling, runaway phenomena, delayed termination

[Branson & Chatburn 2026; Mireles-Cabodevila 2022]

Figure 5 — late cycle (legacy “delayed cycling”). The patient’s neural inspiration ends (the Pmus effort has faded), but the ventilator keeps insufflating; the patient now exhales against the continuing breath, which shows as a terminal spike in airway pressure at end-inspiration. Original schematic; framing per [Branson & Chatburn 2026].

Double / multiple triggering is a consequence, not a type

Notably, neither paper defines “double trigger” as a primary trigger type. Multiple triggering — two or more breaths with little or no expiratory flow between them following a single effort — is a downstream consequence of early triggering, early cycling, or flow discordance [Branson & Chatburn 2026; Mireles-Cabodevila 2022]. Its main danger is breath-stacking: summed tidal volumes causing lung overdistention, a hazard chiefly in volume control (in pressure control, delivered volume still depends on R and C, so stacking is less injurious) [Mireles-Cabodevila 2026 · PVI].

Figure 6 — multiple (double) triggering as a downstream consequence. One prolonged effort triggers a second breath before the first has exhaled; with little expiratory flow between them the tidal volumes stack (toward 2× VT), the overdistention hazard — worst in volume control. Original schematic; framing per [Branson & Chatburn 2026] and [Mireles-Cabodevila 2026 · PVI].

This is the general rule the timing chapter emphasizes — discordance rarely occurs in isolation; one type predictably breeds another (flow discordance → multiple triggering; early cycle → multiple triggering; late cycle → failed triggering), so the discipline is to identify and report the first event in the chain [Branson & Chatburn 2026].

Axis 2 — magnitude, work shifting, and the assistance continuum

The timing axis asks when; the magnitude axis asks how much. When Pmus and Pvent are active together — an active assisted breath, one of the three inspiratory states (with unassisted and passive assisted) — the total work of breathing is shared, and how it is divided is work shifting [Mireles-Cabodevila 2026 · PVI]. This is where the old “flow” vocabulary lands. Legacy flow starvation / flow asynchrony / insufficient flow are reframed here not as timing errors but as manifestations of work shifting — usually under-assistance — because they describe the patient pulling work back from a machine that is giving too little [Mireles-Cabodevila 2026 · PVI; Mireles-Cabodevila 2022]. (Branson & Chatburn list flow discordance as one of three broad forms but treat it as precipitating rather than dissecting it type-by-type [open]; the fuller classification is the magnitude axis of the maxims paper [Branson & Chatburn 2026].)

Work shifting has a waveform signature that depends on the control variable — exactly the reading rule from the waveform method:

• In volume control, flow and volume are fixed, so rising effort shows up in pressure — the characteristic concave “scooping” of the pressure curve. If airway pressure is pulled below PEEP, that is severe work shifting — the patient is doing work on the ventilator — and it is never clinically appropriate [Mireles-Cabodevila 2026 · PVI; Mireles-Cabodevila 2022].
• In pressure control, pressure is fixed, so rising effort shows up as flow and volume above their passive values [Mireles-Cabodevila 2026 · PVI].

Figure 7 — flow starvation / flow asynchrony as under-assistance in volume control, computed directly from the equation of motion Paw = PEEP + R·V̇ + V/C − Pmus. Because flow is fixed, a rising inspiratory effort (Pmus, lower trace) subtracts from airway pressure and scoops the pressure curve concave below the passive reference (dashed). If it pulls airway pressure below PEEP, the patient is doing work on the ventilator — severe work shifting, never clinically appropriate. Original diagram; the reading rule and severity threshold follow [Mireles-Cabodevila 2026 · PVI] and [Mireles-Cabodevila 2022].

Critically, work shifting is not inherently abnormal and can occur with perfect timing [Mireles-Cabodevila 2026 · PVI]. It becomes a problem only at the ends of a continuum. Assistance — the fraction of the work the ventilator does — runs from goal-appropriate, through over-assistance (drive and Pmus suppressed, risking muscle disuse/atrophy and difficult weaning), to under-assistance (raised drive and distress, risking fatigue and myotrauma) [Mireles-Cabodevila 2026 · PVI]. What counts as acceptable is set by the goal of ventilation — safety in acute illness, comfort, or liberation during weaning — the same three goals that anchor mode selection in The Taxonomy of Ventilator Modes [Mireles-Cabodevila 2026 · PVI; Mireles-Cabodevila 2022].

Measuring interaction

The distinguishing emphasis of the 2026 maxims is that interaction should be measured, not just described. Each axis has its metric [Mireles-Cabodevila 2026 · PVI]:

• Timing — the phase difference. The core metric is Δt = t_vent − t_mus (read like error = measured − true): Δt < 0 means Pvent leads (events early), Δt > 0 means Pvent lags (events late), Δt = 0 is synchrony. It can be expressed in absolute time, normalized to the neural inspiratory/expiratory period (to compare across breaths and patients), or as degrees of the ventilatory cycle (for signal-processing and entrainment work) [Mireles-Cabodevila 2026 · PVI].
• Magnitude — the Work Shifting Index (WSI). WSI = (Wpt / Wtot) × 100, the percent of total passive work shifted to the patient: 0% = ventilator does all the work, 100% = patient does all the work, and > 100% = Pmus overrides Pvent (loaded, unproductive breaths). It is most tractable in simulations; the reference standard for partitioning effort is the esophageal-pressure–based Campbell diagram, which is technically demanding and rarely used clinically [Mireles-Cabodevila 2026 · PVI]. The Campbell diagram and the pressure surrogates belong to Bedside Monitoring of Respiratory Mechanics.
• Global burden — the Asynchrony Index (AI). AI = (asynchronous breaths / total respiratory efforts) × 100. The often-quoted AI > 10% threshold is arbitrary and context-dependent — it depends on which discordances you choose to count. Cluster-based metrics and time-based burden (the percent of monitoring time with discordance present) are the other global measures [Mireles-Cabodevila 2026 · PVI].

The paper frames counting itself as three strategies — single-event detection, event-frequency rates (e.g., per 100 breaths), and global indices — and warns that because discordances co-occur within a breath, an “all-inclusive” count and a “first-event-only” count can differ substantially [Mireles-Cabodevila 2026 · PVI].

One gap is stated openly and deserves emphasis: no method yet gives a simple, continuous, bedside index of work shifting [open]. The WSI is a simulation tool, the Campbell diagram is a research procedure, and EAdi-based ratios such as the Patient-Ventilator Breath Contribution ratio require a diaphragm signal — so the magnitude axis, unlike the timing axis, has no easy number a clinician can read at the bedside [Mireles-Cabodevila 2026 · PVI]. Standardized latency thresholds for late triggering and cycling, and the boundaries separating over-, goal-appropriate, and under-assistance, are likewise unknown and named as research needs [Mireles-Cabodevila 2026 · PVI].

Concordance: the goal, and the means to it

Two papers in this corpus describe the desired end state with different words, and it is worth being precise about why that is not a contradiction. Branson & Chatburn name the goal directly: the desired state of interaction is concordance [Branson & Chatburn 2026]. The companion maxims paper never defines a single word “concordance”; instead it specifies the methods for reaching a good interaction — synchrony on the timing axis (Δt = 0) and goal-appropriate assistance on the magnitude axis [Mireles-Cabodevila 2026 · PVI].

The wiki’s resolution (a human editorial ruling, 2026-07-01) keeps both, at different levels of the same idea: concordance is the goal state; synchrony plus goal-appropriate assistance are the means to it. They are not rivals and neither paper’s vocabulary is discarded — the PVI maxims are left unchanged. Achieving concordance, as Branson & Chatburn put it, requires three things together: an understanding of the physiology of the control of breathing, skill in recognizing discordance from the pressure and flow waveforms, and an in-depth knowledge of how the ventilator operates [Branson & Chatburn 2026].

Does discordance cause harm? An honest, out-of-school caveat

It is tempting to treat discordance as self-evidently dangerous. The corpus refuses to. Growing evidence associates discordance with mortality, higher sedation requirements, and longer ventilation — but a cause-and-effect relationship has not been clearly demonstrated [Branson & Chatburn 2026]. Discordance may instead be a marker of illness severity; its impact varies with the type and timing of the event, the lung mechanics, and the magnitude of effort; and some discordance may be beneficial — during the return to patient triggering, minimal efforts (as in early/reverse triggering) may counteract diaphragm disuse atrophy, whereas aggressive efforts cause myotrauma [Branson & Chatburn 2026]. This hedge must be preserved: do not present discordance as a proven cause of harm.

Two boundaries are worth naming. First, the evidence that would settle causation — outcome trials randomizing discordance reduction — lies outside this single-school corpus; the wiki records the association and flags the causal question as a gap to be answered by literature beyond Mireles-Cabodevila and Chatburn, not filled from within it. Second, even recognizing discordance is hard: an editorial in this corpus cites evidence that only about 29% of tested physicians could identify three of four discordance types, that prior training conferred no advantage, and that intensive training raises recognition only partway — motivating the standardized nomenclature, ACLS-style certification, and simulation that the SEVA program is built on [Liendo 2024]. A shared vocabulary is a precondition for teaching the skill at all — which is the whole reason this taxonomy exists.

How this chapter connects

• The whole subject is read off the physics — Equation of Motion for the Respiratory System.
• A mode is the predetermined pattern of interaction; this chapter is the same relationship read in real time — The Taxonomy of Ventilator Modes.
• Discordance is recognized on the tracing, using the control-variable reading rule — Reading Ventilator Waveforms.
• The reference signal (Pmus) and its surrogates — esophageal pressure, the Campbell diagram — belong to Bedside Monitoring of Respiratory Mechanics.

Open

• Supplementary appendix not held. The 2026 maxims paper defers its detailed math, normalization methods, signal-based timing definitions, expiratory-state derivations, and Figure S1 to a supplementary appendix that is not in the frozen artifact — those specifics remain [open] (PMID 41913371).
• No simple bedside work-shifting index. The magnitude axis lacks a continuous, bedside-readable metric; WSI (simulation) and the Campbell diagram (research) are the state of the art [open].
• Undefined thresholds. Standardized latency thresholds for late trigger/cycle, and the boundaries between over-, goal-appropriate, and under-assistance, are not yet established [open].
• Consensus editorial is metadata-only. The 2022 “we need consensus” editorial is held at title-level thesis only [open] [Mireles-Cabodevila 2022 · Consensus].
• Causation is out-of-school. Whether discordance causes harm — versus marking illness severity — awaits outcome trials from outside this single-school corpus.

Sources

Every claim above is drawn from the frozen, human-reviewed primary literature in the machine layer (raw/literature/, one artifact per paper). The short keys used inline resolve to:

• [Chatburn 2020 · Year in Review] — Chatburn RL, Mireles-Cabodevila E. 2019 Year in Review: Patient-Ventilator Synchrony. Respir Care 2020;65(4):558–572. PMID 32213603.
• [Mireles-Cabodevila 2022] — Mireles-Cabodevila E, Siuba MT, Chatburn RL. A Taxonomy for Patient-Ventilator Interactions and a Method to Read Ventilator Waveforms. Respir Care 2022;67(1):129–148. PMID 34470804.
• [Mireles-Cabodevila 2022 · Consensus] — Mireles-Cabodevila E, Gama de Abreu M. Classification and Quantification of Patient-Ventilator Interactions: We Need Consensus! Respir Care 2022;67(5):620–623. PMID 35473853. (editorial; metadata-only artifact — cited for its title-level thesis only)
• [Liendo 2024] — Liendo A, Mireles-Cabodevila E. Closing the Gap in Patient-Ventilator Discordance Recognition. Respir Care 2024;69(2):272–274. PMID 38267228. (editorial; recognition statistics cited from other studies)
• [Branson & Chatburn 2026] — Branson RD, Chatburn RL. Patient-Ventilator Interaction: Timing Discordance in Invasive Ventilation. Respir Care 2026. PMID 42307098.
• [Mireles-Cabodevila 2026 · PVI] — Mireles-Cabodevila E, Vaporidi K, Blanch L, Chatburn RL. Defining and Measuring Patient-Ventilator Interactions: 10 Fundamental Maxims. Respir Care 2026;71(6):601–629. PMID 41913371.

This chapter is the human-layer synthesis of four one-concept-per-page records in the machine layer — Patient-Ventilator Interaction, Patient-Ventilator Discordance, Timing Discordance, and Ten Fundamental Maxims of Patient-Ventilator Interaction — and the Lit — … source summaries they cite (see the derived_from field).