scholarly journals Cardiopulmonary coupling indices to assess weaning readiness from mechanical ventilation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Pablo Armañac-Julián ◽  
David Hernando ◽  
Jesús Lázaro ◽  
Candelaria de Haro ◽  
Rudys Magrans ◽  
...  
Keyword(s):  
Heart Rate ◽  
Mechanical Ventilation ◽  
Spontaneous Breathing Trial ◽  
Sinus Arrhythmia ◽  
Time Frequency ◽  
Cardiopulmonary Coupling ◽  
Cardiac Pumping ◽  
Successful Weaning ◽  
Frequency Coherence ◽  
Subspace Projections

AbstractThe ideal moment to withdraw respiratory supply of patients under Mechanical Ventilation at Intensive Care Units (ICU), is not easy to be determined for clinicians. Although the Spontaneous Breathing Trial (SBT) provides a measure of the patients’ readiness, there is still around 15–20% of predictive failure rate. This work is a proof of concept focused on adding new value to the prediction of the weaning outcome. Heart Rate Variability (HRV) and Cardiopulmonary Coupling (CPC) methods are evaluated as new complementary estimates to assess weaning readiness. The CPC is related to how the mechanisms regulating respiration and cardiac pumping are working simultaneously, and it is defined from HRV in combination with respiratory information. Three different techniques are used to estimate the CPC, including Time-Frequency Coherence, Dynamic Mutual Information and Orthogonal Subspace Projections. The cohort study includes 22 patients in pressure support ventilation, ready to undergo the SBT, analysed in the 24 h previous to the SBT. Of these, 13 had a successful weaning and 9 failed the SBT or needed reintubation –being both considered as failed weaning. Results illustrate that traditional variables such as heart rate, respiratory frequency, and the parameters derived from HRV do not differ in patients with successful or failed weaning. Results revealed that HRV parameters can vary considerably depending on the time at which they are measured. This fact could be attributed to circadian rhythms, having a strong influence on HRV values. On the contrary, significant statistical differences are found in the proposed CPC parameters when comparing the values of the two groups, and throughout the whole recordings. In addition, differences are greater at night, probably because patients with failed weaning might be experiencing more respiratory episodes, e.g. apneas during the night, which is directly related to a reduced respiratory sinus arrhythmia. Therefore, results suggest that the traditional measures could be used in combination with the proposed CPC biomarkers to improve weaning readiness.

scholarly journals Weaning from Mechanical Ventilation: On the Improvement of the Prediction of Patients' Readiness with Cardiopulmonary Coupling Indices

2020 ◽  
Author(s):  
Pablo Armañac-Julián ◽  
David Hernando ◽  
Jesús Lázaro ◽  
Candelaria de Haro ◽  
Rudys Magrans ◽  
...  
Keyword(s):  
Heart Rate ◽  
Mechanical Ventilation ◽  
Spontaneous Breathing Trial ◽  
Time Frequency ◽  
Cardiopulmonary Coupling ◽  
Cardiac Pumping ◽  
Successful Weaning ◽  
The Moment ◽  
Frequency Coherence ◽  
Subspace Projections

Abstract The ideal moment to withdraw respiratory supply of patients under Mechanical Ventilation (MV) at Intensive Care Units (ICU), is not easy to be determined for clinicians. Although the Spontaneous Breathing Trial (SBT) provides a measure of the patients’ readiness, there is still around 15-20% of predictive failure rate. This work explores both Heart Rate Variability (HRV) and Cardiopulmonary Coupling (CPC) estimates as complementary information for readiness prediction. The CPC is related to how the mechanisms regulating respiration and cardiac pumping are working simultaneously, and it is defined from HRV in combination with respiratory information. Three different techniques are used to measure CPC, including Orthogonal Subspace Projections, Dynamic Mutual Information and Time-Frequency Coherence. 22 patients undergoing SBT in pressure support ventilation are analysed in the 24 hours previous to the SBT. 13 had a successful weaning and 9 failed the SBT or needed reintubation –being both considered as failed weaning. Results illustrate that traditional variables such as heart rate, respiratory frequency, and the parameters derived from HRV do not differ in patients with successful or failed weaning. However, significant statistical differences are found for the novel CPC parameters, throughout the whole recordings, comparing the values of the two groups. In addition, the night prior to SBT is the moment where differences are higher, probably because patients with failed weaning might be experiencing more respiratory episodes, e.g. apneas during the night, which is directly related to a reduced RSA. Therefore, results suggest that the traditional measures could be used in combination with these novel CPC biomarkers to help clinicians better predict if patients are ready to be weaned.

scholarly journals Time-Frequency Analysis of Cardiovascular and Cardiorespiratory Interactions During Orthostatic Stress by Extended Partial Directed Coherence

Entropy ◽  
2019 ◽  
Vol 21 (5) ◽  
pp. 468 ◽  
Author(s):  
Sonia Charleston-Villalobos ◽  
Sina Reulecke ◽  
Andreas Voss ◽  
Mahmood R. Azimi-Sadjadi ◽  
Ramón González-Camarena ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Systolic Blood Pressure ◽  
Information Flow ◽  
Orthostatic Intolerance ◽  
Linear Method ◽  
Orthostatic Stress ◽  
Partial Directed Coherence ◽  
Sinus Arrhythmia ◽  
Time Frequency

In this study, the linear method of extended partial directed coherence (ePDC) was applied to establish the temporal dynamic behavior of cardiovascular and cardiorespiratory interactions during orthostatic stress at a 70° head-up tilt (HUT) test on young age-matched healthy subjects and patients with orthostatic intolerance (OI), both male and female. Twenty 5-min windows were used to analyze the minute-wise progression of interactions from 5 min in a supine position (baseline, BL) until 18 min of the orthostatic phase (OP) without including pre-syncopal phases. Gender differences in controls were present in cardiorespiratory interactions during OP without compromised autonomic regulation. However in patients, analysis by ePDC revealed considerable dynamic alterations within cardiovascular and cardiorespiratory interactions over the temporal course during the HUT test. Considering the young female patients with OI, the information flow from heart rate to systolic blood pressure (mechanical modulation) was already increased before the tilt-up, the information flow from systolic blood pressure to heart rate (neural baroreflex) increased during OP, while the information flow from respiration to heart rate (respiratory sinus arrhythmia) decreased during the complete HUT test. Findings revealed impaired cardiovascular interactions in patients with orthostatic intolerance and confirmed the usefulness of ePDC for causality analysis.

Cardiac autonomic control during balloon carotid angioplasty and stenting

2003 ◽  
Vol 81 (10) ◽  
pp. 944-951 ◽  
Author(s):  
Laurence Mangin ◽  
Claire Medigue ◽  
Jean-Claude Merle ◽  
Isabelle Macquin-Mavier ◽  
Philippe Duvaldestin ◽  
...  
Keyword(s):  
Heart Rate ◽  
Internal Carotid ◽  
Autonomic Control ◽  
Frequency Domain Method ◽  
Carotid Angioplasty ◽  
Sinus Arrhythmia ◽  
Time Frequency ◽  
Carotid Baroreceptor ◽  
Baroreceptor Stimulation ◽  
Carotid Baroreceptor Stimulation

Hemodynamic alterations during balloon carotid angioplasty (BCA) and stenting have been ascribed to the consequences of direct carotid baroreceptor stimulation during balloon inflation. BCA with stenting in patients with carotid atheromatous stenoses offers a unique opportunity for elucidating the cardiovascular autonomic response to direct transient intravascular stimulation of the baroreceptors. We analysed the consequences of BCA on the autonomic control of heart rate and on breathing components in nine patients with atheromatous stenoses involving the bifurcation and the internal carotid. A time–frequency domain method, the smoothed pseudo-Wigner–Ville transform (SPWVT), was used to evaluate the spectral parameters (i.e., the instantaneous amplitude and centre frequency (ICF) of the cardiovascular and respiratory oscillations). Those parameters and their dynamics (8 and 24 h later) were evaluated during and after the procedure. BCA stimulates baroreceptors in all patients, which markedly reduces heart rate and blood pressure. Vagal baroreflex activation altered the respiratory sinus arrhythmia in terms of amplitude and frequency (ICF HF RR shifted from 0.27 ± 0.03 to 0.23 ± 0.04 Hz pre-BCA vs. BCA, respectively; p < 0.01). Both the high- and low-frequency amplitudes of heart rate oscillations were altered during carotid baroreceptor stimulation, strongly supporting a contribution of the baroreflex to the generation of both oscillations of heart rate. Carotid baroreceptors stimulation increased the inspiratory time (Ti) (1.5 ± 0.5 to 2.3 ± 0.6 s pre-BCA vs. BCA, respectively; p < 0.01). In awake patients, BCA with stenting of atheromatous stenosis involving the bifurcation and internal carotid causes marked changes in the cardiac autonomic and respiratory control systems.Key words: carotid angioplasty, heart rate variability, autonomic nervous system, respiration, spectral analysis.

scholarly journals Influence of lung aeration on diaphragmatic contractility during a spontaneous breathing trial: an ultrasound study

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
Jing Xia ◽  
Chuan-Yun Qian ◽  
Li Yang ◽  
Mei-Ju Li ◽  
Xiao-Xue Liu ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Spontaneous Breathing ◽  
Spontaneous Breathing Trial ◽  
Quiet Breathing ◽  
Diaphragmatic Function ◽  
Lung Aeration ◽  
Ultrasound Study ◽  
Weaning Failure ◽  
Successful Weaning ◽  
The Right

Abstract Background A spontaneous breathing trial (SBT) is a major diagnostic tool to predict successfully extubation in patients. Several factors may lead to weaning failure, including the degree of lung aeration loss and diaphragm dysfunction. The main objective was to compare the diaphragmatic contractility between patients with high lung aeration loss and low lung aeration loss during a 30-minute SBT by ultrasound. Methods This was a prospective single-center study. Lung ultrasound aeration score (LUS) and diaphragmatic thickening fraction (DTF) were measured during mechanical ventilation 1 h before SBT (T-1), 30 min (T1), and 120 min (T2) after the start of the SBT during quiet breathing. The right and left DTF were compared between patients with LUS ≥ 14 (high lung aeration loss), considered at high risk of post-extubation distress, and those with LUS < 14 (low lung aeration loss). The relationship between the LUS and DTF and the changes in LUS and DTF from T-1 to T2 in patients with LUS ≥ 14 were assessed. Results Forty-nine patients were analyzed; 33 had LUS ≥ 14 and 16 had LUS < 14 at T1. The DTF at T1 was significantly higher in patients with LUS ≥ 14 than in those with LUS < 14: the right median (IQR) DTF was 22.2% (17.1 to 30.9%) vs. 14.8% (10.2 to 27.0%) (p = 0.035), and the left median (IQR) DTF was 25.0% (18.4 to 35.0%) vs. 18.6% (9.7 to 24.2%) (p = 0.017), respectively. There was a moderate positive correlation between the LUS and the DTF (Rho = 0.3, p = 0.014). A significant increase in the LUS was observed from T-1 to T1, whereas no change was found between T1 and T2. The DTF remained stable from T-1 to T2. Conclusions During a SBT, diaphragmatic contraction acts differently depending on the degree of pulmonary aeration. In patients with high lung aeration loss, increased diaphragmatic contractility indicates an additional respiratory effort to compensate lung volume loss that would contribute to successful SBT. Further studies are needed to evaluate the combined evaluation of lung aeration and diaphragmatic function to predict the successful weaning of patients from mechanical ventilation.

Coherence analysis between respiration and heart rate variability using continuous wavelet transform

2009 ◽  
Vol 367 (1892) ◽  
pp. 1393-1406 ◽  
Author(s):  
Kobi Keissar ◽  
Linda R Davrath ◽  
Solange Akselrod
Keyword(s):  
Heart Rate ◽  
Wavelet Transform ◽  
Continuous Wavelet Transform ◽  
Autonomous Nervous System ◽  
Continuous Wavelet ◽  
Sinus Arrhythmia ◽  
Cardiovascular Variability ◽  
Time Frequency ◽  
Stationary Signals ◽  
Specific Frequency

The continuous wavelet transform (CWT) is specifically efficient in the analysis of transient and non-stationary signals. As such, it has become a powerful candidate for time–frequency analysis of cardiovascular variability. CWT has already been established as a valid tool for the analysis of single cardiovascular signals, providing additional insights into the autonomous nervous system (ANS) activity and its control mechanism. Intercorrelation between cardiovascular signals elucidates the function of ANS central control and the peripheral reflex mechanisms. Wavelet transform coherence (WTC) can provide insight into the transient linear order of the regulatory mechanisms, via the computation of time–frequency maps of the time-variant coherence. This paper presents a framework for applying WTC for quantitative analysis of coherence in cardiovascular variability research. Computer simulations were performed to estimate the accuracy of the WTC estimates and a method for determining the coherence threshold for specific frequency band was developed and evaluated. Finally, we demonstrated, in two representative situations, the dynamic behaviour of respiration sinus arrhythmia through the analysis of the WTC between heart rate and respiration signals. This emphasizes that CWT and its application to WTC is a useful tool for dynamic analysis of cardiovascular variability.

scholarly journals Tracking Rhythms Coherence From Polysomnographic Records: A Time-Frequency Approach

2021 ◽  
Vol 7 ◽  
Author(s):  
Alexandre Guillet ◽  
Alain Arneodo ◽  
Françoise Argoul
Keyword(s):  
Wavelet Transforms ◽  
Dynamical Process ◽  
Frequency Range ◽  
Sinus Arrhythmia ◽  
Time Frequency ◽  
Physiological Processes ◽  
Spectral Ranges ◽  
Frequency Coherence ◽  
The Brain ◽  
Organ Dysfunctions

The crosstalk between organs plays a crucial role in physiological processes. This coupling is a dynamical process, it must cope with a huge variety of rhythms with frequencies ranging from milliseconds to hours, days, seasons. The brain is a central hub for this crosstalk. During sleep, automatic rhythmic interrelations are enhanced and provide a direct insight into organ dysfunctions, however their origin remains a difficult issue, in particular in sleep disorders. In this study, we focus on EEG, ECG, and airflow recordings from polysomnography databases. Because these signals are non-stationary, non-linear, noisy, and span wide spectral ranges, a time-frequency analysis, based on wavelet transforms, is more appropriate to handle this complexity. We design a wavelet-based extraction method to identify the characteristic rhythms of these different signals, and their temporal variability. These new constructs are combined in pairs to compute their wavelet-based time-frequency complex coherence. These time-frequency coherence maps highlight the occurrence of a slowly modulated coherence pattern in the frequency range [0.01–0.06] Hz, which appears in both obstructive and central apnea. A preliminary exploration of a large database from the National Sleep Research Resource with respiration disorders, such as apnea provides some clues on its relation with autonomic cardio-respiratory coupling and brain rhythms. We also observe that during sleep apnea episodes (either obstructive or central), the cardiopulmonary coherence (in particular respiratory sinus-arrhythmia) in the frequency range [0.1–0.7] Hz strongly diminishes, suggesting a modification of this coupling. Finally, comparing time-averaged coherence with heart rate variability spectra in different apnea episodes, we discuss their common trait and their differences.

Measures of RSA Suppression, Attentional Control, and Negative Affect Predict Self-Ratings of Executive Functions

2011 ◽  
Vol 25 (4) ◽  
pp. 164-173 ◽  
Author(s):  
Brian Healy ◽  
Aaron Treadwell ◽  
Mandy Reagan
Keyword(s):  
College Students ◽  
Heart Rate ◽  
Regression Analysis ◽  
Individual Differences ◽  
Negative Affect ◽  
Respiratory Sinus Arrhythmia ◽  
Attentional Control ◽  
Executive Processes ◽  
Sinus Arrhythmia ◽  
Low Levels

The current study was an attempt to determine the degree to which the suppression of respiratory sinus arrhythmia (RSA) and attentional control were influential in the ability to engage various executive processes under high and low levels of negative affect. Ninety-four college students completed the Stroop Test while heart rate was being recorded. Estimates of the suppression of RSA were calculated from each participant in response to this test. The participants then completed self-ratings of attentional control, negative affect, and executive functioning. Regression analysis indicated that individual differences in estimates of the suppression of RSA, and ratings of attentional control were associated with the ability to employ executive processes but only when self-ratings of negative affect were low. An increase in negative affect compromised the ability to employ these strategies in the majority of participants. The data also suggest that high attentional control in conjunction with attenuated estimates of RSA suppression may increase the ability to use executive processes as negative affect increases.

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