The Injurious Effects of Elevated or Nonelevated Respiratory Rate during Mechanical Ventilation

Objective Clinicians cannot precisely determine the time for withdrawal of ventilation. We aimed to evaluate the performance of driving pressure (DP)×respiratory rate (RR) to predict the outcome of weaning. Methods Plateau pressure (Pplat) and total positive end-expiratory pressure (PEEPtot) were measured during mechanical ventilation with brief deep sedation and on volume-controlled mechanical ventilation with a tidal volume of 6 mL/kg and a PEEP of 0 cmH2O. Pplat and PEEPtot were measured by patients holding their breath for 2 s after inhalation and exhalation, respectively. DP was determined as Pplat minus PEEPtot. The rapid shallow breathing index was measured from the ventilator. The highest RR was recorded within 3 minutes during a spontaneous breathing trial. Patients who tolerated a spontaneous breathing trial for 1 hour were extubated. Results Among the 105 patients studied, 44 failed weaning. During ventilation withdrawal, DP×RR was 136.7±35.2 cmH2O breaths/minute in the success group and 230.2±52.2 cmH2O breaths/minute in the failure group. A DP×RR index >170.8 cmH2O breaths/minute had a sensitivity of 93.2% and specificity of 88.5% to predict failure of weaning. Conclusions Measurement of DP×RR during withdrawal of ventilation may help predict the weaning outcome. A high DP×RR increases the likelihood of weaning failure. Statement: This manuscript was previously posted as a preprint on Research Square with the following link: https://www.researchsquare.com/article/rs-15065/v3 and DOI: 10.21203/rs.2.24506/v3

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Vagal feedback in the entrainment of respiration to mechanical ventilation in sleeping humans

Journal of Applied Physiology ◽

10.1152/jappl.2000.89.2.760 ◽

2000 ◽

Vol 89 (2) ◽

pp. 760-769 ◽

Cited By ~ 31

Author(s):

Peggy M. Simon ◽

Alfred M. Habel ◽

J. Andrew Daubenspeck ◽

J. C. Leiter

Keyword(s):

Mechanical Ventilation ◽

Respiratory Rate ◽

Eye Movement ◽

Lung Transplant ◽

Respiratory Activity ◽

Nrem Sleep ◽

Normal Subjects ◽

The Other ◽

Absolute Requirement ◽

Striking Contrast

We studied the capacity of four “normal” and six lung transplant subjects to entrain neural respiratory activity to mechanical ventilation. Two transplant subjects were studied during wakefulness and demonstrated entrainment indistinguishable from that of normal awake subjects. We studied four normal subjects and four lung transplant subjects during non-rapid eye movement (NREM) sleep. Normal subjects entrained to mechanical ventilation over a range of ventilator frequencies that were within ±3–5 breaths of the spontaneous respiratory rate of each subject. After lung transplantation, during which the vagi were cut, subjects did demonstrate entrainment during NREM sleep; however, entrainment only occurred at ventilator frequencies at or above each subject's spontaneous respiratory rate, and entrainment was less effective. We conclude that there is no absolute requirement for vagal feedback to induce entrainment in subjects, which is in striking contrast to anesthetized animals in which vagotomy uniformly abolishes entrainment. On the other hand, vagal feedback clearly enhances the fidelity of entrainment and extends the range of mechanical frequencies over which entrainment can occur.

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Use of High-Flow Nasal Cannula in Patients With Pneumonia and Hypoxemic Respiratory Failure at Altitudes Above 2600 m: What Is the Best Predictor of Success?

Journal of Intensive Care Medicine ◽

10.1177/08850666211057503 ◽

2021 ◽

pp. 088506662110575

Author(s):

Molano Franco Daniel ◽

Gómez Duque Mario ◽

Beltrán Edgar ◽

Villabon Mario ◽

Hurtado Alejandra ◽

...

Keyword(s):

Mechanical Ventilation ◽

Respiratory Failure ◽

Respiratory Rate ◽

High Flow ◽

Nasal Cannula ◽

High Flow Nasal Cannula ◽

Multicenter Cohort Study ◽

Hypoxemic Respiratory Failure ◽

Severity Scores ◽

High Flow Oxygen

Introduction: The use of high-flow nasal cannulas (HFNC) in patients with hypoxemic ventilatory failure reduces the need for mechanical ventilation and does not increase mortality when intubation is promptly applied. The aim of the study is to describe the behavior of HFNC in patients who live at high altitudes, and the performance of predictors of success/failure of this strategy. Methods: Prospective multicenter cohort study, with patients aged over 18 years recruited for 12 months in 2020 to 21. All had a diagnosis of hypoxemic respiratory failure secondary to pneumonia, were admitted to intensive care units, and were receiving initial management with a high-flow nasal cannula. The variables assessed included need for intubation, mortality in ICU, and the validation of SaO2, respiratory rate (RR) and ROX index (IROX) as predictors of HFNC success / failure. Results: One hundred and six patients were recruited, with a mean age of 59 years and a success rate of 74.5%. Patients with treatment failure were more likely to be obese (BMI 27.2 vs 25.5; OR: 1.03; 95% CI: .95-1.1) and had higher severity scores at admission (APACHE II 12 vs 20; OR 1.15; 95% CI: 1.06-1.24). Respiratory rates after 12 (AUC .81 CI: .70-.92) and 18 h (AUC .85 CI: .72-0.90) of HFNC use were the best predictors of failure, performing better than those that included oxygenation. ICU mortality was higher in the failure group (6% vs 29%; OR 8.8; 95% CI:1.75-44.7). Conclusions: High-flow oxygen cannula therapy in patients with hypoxemic respiratory failure living at altitudes above 2600 m is associated with low rates of therapy failure and a reduced need for mechanical ventilation in the ICU. The geographical conditions and secondary physiological changes influence the performance of the traditionally validated predictors of therapy success. Respiratory rate <30 proved to be the best indicator of early success of the device at 12 h of use.

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Decreased respiratory rate variability during mechanical ventilation is associated with increased mortality

Intensive Care Medicine ◽

10.1007/s00134-013-2937-5 ◽

2013 ◽

Vol 39 (8) ◽

pp. 1359-1367 ◽

Cited By ~ 16

Author(s):

Guillermo Gutierrez ◽

Aparna Das ◽

Guillermo Ballarino ◽

Arshan Beyzaei-Arani ◽

Hülya Türkan ◽

...

Keyword(s):

Mechanical Ventilation ◽

Respiratory Rate ◽

Respiratory Rate Variability

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Prone Position after Liberation from Prolonged Mechanical Ventilation in COVID-19 Respiratory Failure

Critical Care Research and Practice ◽

10.1155/2020/6688120 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Andrei Karpov ◽

Anish R. Mitra ◽

Sarah Crowe ◽

Gregory Haljan

Keyword(s):

Intensive Care Unit ◽

Mechanical Ventilation ◽

Intensive Care ◽

Respiratory Failure ◽

Respiratory Rate ◽

Prolonged Mechanical Ventilation ◽

Case Series ◽

Prone Positioning ◽

Retrospective Case ◽

Number Of Patients

Objective and Rationale. Prone positioning of nonintubated patients has prevented intubation and mechanical ventilation in patients with respiratory failure from coronavirus disease 2019 (COVID-19). A number of patients in a recently published cohort have undergone postextubation prone positioning (PEPP) following liberation from prolonged mechanical ventilation in attempt to prevent reintubation. The objective of this study is to systematically search the literature for reports of PEPP as well as describe the feasibility and outcomes of PEPP in patients with COVID-19 respiratory failure. Design. This is a retrospective case series describing the feasibility and tolerability of postextubation prone positioning (PEPP) and its impact on physiologic parameters in a tertiary intensive care unit during the COVID-19 pandemic. Setting and Patients. This study was conducted on patients with COVID-19 respiratory failure hospitalized in a tertiary Intensive Care Unit at Surrey Memorial Hospital during the COVID-19 pandemic. Measurements and Results. We did not find prior reports of PEPP following prolonged intubation in the literature. Four patients underwent a total of 13 PEPP sessions following liberation from prolonged mechanical ventilation. Each patient underwent a median of 3 prone sessions (IQR: 2, 4.25) lasting a median of 1.5 hours (IQR: 1.2, 2.1). PEPP sessions were associated with a reduction in median oxygen requirements, patient respiratory rate, and reintubation rate. The sessions were well tolerated by patients, nursing, and the allied health team. Conclusions. The novel practice of PEPP after liberation from prolonged mechanical ventilation in patients with COVID-19 respiratory failure is feasible and well tolerated, and may be associated with favourable clinical outcomes including improvement in oxygenation and respiratory rate and a low rate of reintubation. Larger prospective studies of PEPP are warranted.

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Memperbaiki Saturasi Oksigen, Frekuensi Denyut Jantung, dan Pernafasan Neonatus yang Menggunakan Ventilasi Mekanik Dengan Terapi Musik

Jurnal Keperawatan Indonesia ◽

10.7454/jki.v16i3.324 ◽

2013 ◽

Vol 16 (3) ◽

pp. 154-160 ◽

Cited By ~ 1

Author(s):

Rahmadevita S.A.M ◽

Yeni Rustina ◽

Elfi Syahreni

Keyword(s):

Heart Rate ◽

Mechanical Ventilation ◽

Music Therapy ◽

Oxygen Saturation ◽

Respiratory Rate ◽

T Test ◽

P Value ◽

Respiratory Disorder ◽

Significant Difference ◽

Paired T Test

AbstrakNeonatus yang menggunakan ventilasi mekanik akibat gangguan pernapasan mengalami masalah oksigenisasi dan frekuensi denyut jantung. Berbagai upaya perlu dilakukan agar neonates tenang sehingga kebutuhan oksigen dapat diminimalkan, salah satu upaya tersebut adalah terapi musik. Penelitian ini bertujuan untuk menguji pengaruh terapi musik terhadap saturasi oksigen, frekuensi denyut jantung dan frekuensi pernafasan neonatus yang menggunakan ventilasi mekanik. Penelitian kuasi eksperimen dengan rancangan pretest-posttest without control meibatkan 13 neonatus yang dipilih secara konsekutif. Intervensi yang diberikan adalah terapi musik dengan Brahm’s Lullaby selama 30 menit dengan headphone. Pengumpulan data menggunakan observasi dan dianalisis dengan Paired t test. Hasil penelitian menunjukkan adanya perbedaan bermakna antara rerata saturasi oksigen, frekuensi denyut jantung dan frekuensi pernafasan sebelum dan setelah pemberian terapi musik. Pada saturasi oksigen terjadi peningkatan, sedangkan pada frekuensi denyut jantung dan pernapasan mengalami penurunan. Terapi musik dapat digunakan sebagai pendamping terapi medis untuk memperbaiki oksigenisasi pada neonatus yang menggunakan ventilasi mekanik.Kata kunci: denyut jantung neonatus, pernapasan, saturasi oksigen, terapi musik, ventilasi mekanikAbstractImproving Oxygen Saturation, Heart Rate, and Respiratory Rate of Neonates Using Mechanical Ventilation with Music Therapy. Neonates using mechanical ventilation cause of respiratory disorder experience oxygenation and heart rate problems. Interventions should be made in order to calm neonates so that the need of oxygen can be minimized, one of these interventions is music therapy. This study aimed to identify the effect of music therapy on oxygen saturation, heart rate and respiratory rate of neonates using mechanical ventilation. This quasi experiment study with a pretest-posttest design without control involved 13 neonates selected by consecutive sampling. Data collected through observation and analyzed by paired t test. There was a significant difference on the average of oxygen saturation, heart rate and respiratory rate of infants using mechanical ventilation before and after music therapy (p value <0,05). Music therapy can be used as a complementary medical therapies to improve oxygenation in neonates using mechanical ventilation.Key words: heart rate, mechanical ventilation, music therapy, neonate, oxygen saturation, respiratory rate

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Use of the product of driving pressure and respiratory rate for predicting failure of weaning from mechanical ventilator in medical patients

10.21203/rs.2.24506/v1 ◽

2020 ◽

Author(s):

Ju Gong ◽

Bibo Zhang ◽

Xiaowen Huang ◽

Bin Li ◽

Jian Huang

Keyword(s):

Mechanical Ventilation ◽

Respiratory Rate ◽

Spontaneous Breathing Trial ◽

Plateau Pressure ◽

Driving Pressure ◽

Medical Patients ◽

Failure Group ◽

Weaning Failure ◽

Weaning Outcome

Abstract Background : Respiratory workload increment in the process of mechanical ventilation withdrawal is critical for the determination of weaning outcome. Pressure, tidal volume (Vt) and respiratory rate (RR ) are considered as patient’s respiratory power, albeit being affected by excessive respiratory load. We aimed to evaluate the performance of driving pressure (DP)×RR to predict the outcome of weaning. Methods : Plateau pressure (Pplat) and positive end-expiratory pressure tot (PEEPtot) were measured during mechanical ventilation, viz., (1) brief deep sedation, (2) on volume support ventilation of MV with Vt 6 ml/kg and a PEEP of 0 cm H 2 O, (3) Pplat and PEEPtot were measured by holding breath for 2s after inhalation and exhalation, respectively. The DP was determined as Pplat minus PEEPtot. The highest RR was recorded within 3 min during spontaneous-breathing trial (SBT). Patients that were able to tolerate SBT for 1 h were directly extubated. These measurements correlated well with weaning outcome. Notably, patients in the “failure” group failed the SBT, died, while others required reintubation or noninvasive ventilation within 48 h of extubation. Results : Out of the 61 patients studied, 22 failed weaning. During the withdrawal of ventilation, DP×RR was 134.2±33.2 cmH 2 O ·breaths/min and 238.5±61.7 cmH 2 O·breaths/min ( P =0.00), DP was 7.9±1.6 cmH 2 O and 9.7±2.3 cmH 2 O ( P =0.00), in the “success” and “failure” groups, respectively. The DP×RR index greater than 170 cmH 2 O·breaths/min had a sensitivity of 95.5% and a specificity of 89.7%, while DP index greater than 8.1 cmH 2 O had 81.8% sensitivity and 64.1% specificity to predict weaning failure. Conclusions : Measurement of DP×RR during withdrawal of ventilation may help predict weaning outcome. Noticeably, high DP×RR increased the likelihood of weaning failure.

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