Response to the letter: Esophageal pressure and potential confounders for evaluating patient-ventilator asynchrony

Dear Editor, This letter is in response to the letter by Suzuki et al., which argued that additional data and further analyses of our paper (Sousa et al. 2020 [1]) would be helpful for the precise evaluation of asynchrony and its clinical impact on outcomes. Dr. Suzuki argues that asynchrony could have been more frequent in COPD patients [3], and we agree, therefore we captured this information at admission and included it in our logistic regression analysis to identify predictors of high incidence of asynchrony (asynchrony index ≥10%), but in our study population COPD was not associated with asynchrony during the entire period of mechanical ventilation (AITOTAL), OR:0.53, 95%CI:0.06–4.49, nor with asynchrony during assisted ventilation (AIASSISTED), OR:0.43, 95%CI:0.05–3.67. Since our objective was to assess asynchrony during the entire period of mechanical ventilation, we used an automated system of detection of asynchrony, which might not be feasible with esophageal pressure monitoring.