Simplifying the measurement of neural respiratory drive index: parasternal electromyogram to measure respiratory rate

The objective of this study was to compare patient-ventilator interaction during pressure-support ventilation (PSV) and proportional-assist ventilation (PAV) in the course of increased ventilatory requirement obtained by adding a dead space in 12 patients on weaning from mechanical ventilation. With PSV, the level of unloading was provided by setting the inspiratory pressure at 20 and 10 cmH2O, whereas with PAV the level of unloading was at 80 and 40% of the elastic and resistive load. Hypercapnia increased (P < 0.001) tidal swing of esophageal pressure and pressure-time product per breath at both levels of PSV and PAV. During PSV, application of dead space increased ventilation (VE) during PSV (67 +/- 4 and 145 +/- 5% during 20 and 10 cmH2O PSV, respectively, P < 0.001). This was due to a relevant increase in respiratory rate (48 +/- 4 and 103 +/- 5% during 20 and 10 cmH2O PSV, respectively, P < 0.001), whereas the increase in tidal volume (VT) played a small role (13 +/- 1 and 21 +/- 2% during 20 and 10 cmH2O PSV, respectively, P < 0.001). With PAV, the increase in VE consequent to hypercapnia (27 +/- 3 and 64 +/- 4% during 80 and 40% PAV, respectively, P < 0.001) was related to the increase in VT (32 +/- 1 and 66 +/- 2% during 80 and 40% PAV, respectively, P < 0.001), respiratory rate remaining unchanged. The increase in pressure-time product per minute and per liter consequent to acute hypercapnia and the sense of breathlessness were significantly (P < 0.001) higher during PSV than during PAV. Our data show that, after hypercapnic stimulation of the respiratory drive, the capability to increase VE through changes in VT modulated by variations in inspiratory muscle effort is preserved only during PAV; the compensatory strategy used to increase VE during PSV requires greater muscle effort and causes more pronounced patient discomfort than during PAV.

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Opioid-induced Respiratory Depression Is Only Partially Mediated by the preBötzinger Complex in Young and Adult Rabbits In Vivo

Anesthesiology ◽

10.1097/aln.0000000000000628 ◽

2015 ◽

Vol 122 (6) ◽

pp. 1288-1298 ◽

Cited By ~ 22

Author(s):

Astrid G. Stucke ◽

Justin R. Miller ◽

Ivana Prkic ◽

Edward J. Zuperku ◽

Francis A. Hopp ◽

...

Keyword(s):

Respiratory Rate ◽

Respiratory Depression ◽

Respiratory Rhythm ◽

Respiratory Drive ◽

Phase Duration ◽

Homocysteic Acid ◽

Opioid Receptor Agonist ◽

Prebotzinger Complex ◽

Prebötzinger Complex

Abstract Background: The preBötzinger Complex (preBC) plays an important role in respiratory rhythm generation. This study was designed to determine whether the preBC mediated opioid-induced respiratory rate depression at clinically relevant opioid concentrations in vivo and whether this role was age dependent. Methods: Studies were performed in 22 young and 32 adult New Zealand White rabbits. Animals were anesthetized, mechanically ventilated, and decerebrated. The preBC was identified by the tachypneic response to injection of d,l-homocysteic acid. (1) The μ-opioid receptor agonist [d-Ala2,N-Me-Phe4,Gly-ol]-enkephalin (DAMGO, 100 μM) was microinjected into the bilateral preBC and reversed with naloxone (1 mM) injection into the preBC. (2) Respiratory depression was achieved with intravenous remifentanil (0.08 to 0.5 μg kg−1 min−1). Naloxone (1 mM) was microinjected into the preBC in an attempt to reverse the respiratory depression. Results: (1) DAMGO injection depressed respiratory rate by 6 ± 8 breaths/min in young and adult rabbits (mean ± SD, P < 0.001). DAMGO shortened the inspiratory and lengthened the expiratory fraction of the respiratory cycle by 0.24 ± 0.2 in adult and young animals (P < 0.001). (2) During intravenous remifentanil infusion, local injection of naloxone into the preBC partially reversed the decrease in inspiratory fraction/increase in expiratory fraction in young and adult animals (0.14 ± 0.14, P < 0.001), but not the depression of respiratory rate (P = 0.19). PreBC injections did not affect respiratory drive. In adult rabbits, the contribution of non-preBC inputs to expiratory phase duration was larger than preBC inputs (3.5 [−5.2 to 1.1], median [25 to 75%], P = 0.04). Conclusions: Systemic opioid effects on respiratory phase timing can be partially reversed in the preBC without reversing the depression of respiratory rate.

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Does caffeine improve respiratory rate during remifentanil target controlled infusion sedation? A case report in endoscopic sedation

Journal of Opioid Management ◽

10.5055/jom.2017.0376 ◽

2017 ◽

Vol 13 (2) ◽

pp. 125 ◽

Cited By ~ 2

Author(s):

Fabio Sbaraglia, MD ◽

Mariella De Riso, MD ◽

Maria Elena Riccioni, MD ◽

Guido Costamagna, MD ◽

Maria Sammartino, MD

Keyword(s):

Respiratory Rate ◽

Protective Role ◽

Respiratory Center ◽

Respiratory Drive ◽

Remifentanil Infusion ◽

Impaired Patient ◽

Target Controlled Infusion ◽

Therapeutic Colonoscopy ◽

Positive Effect ◽

Neonatal Apnea

Sedation for endoscopic procedures may be challenging when facing patients with high risk. Traditional techniques, as propofol or meperidine/midazolam administration, cannot ensure an adequate level of safety and efficacy for these patients. Remifentanil infusion is a common alternative, but the incidence of apneic events does not allow achieving safely a good level of analgesia. To overcome with this issue, the authors borrowed suggestions from other medical fields. The clinical practice has recognized a wide utility of methylxanthines (caffeine, theophylline, etc). The positive effect of caffeine on the airways function is known and in the treatment of neonatal apnea, it works as direct stimulant of central respiratory center. Furthermore, preclinical studies suggest that methylxanthines could have a protective role on the opioids inhibition of the bulbar-pontine respiratory center. As described in this report, the authors observed that, also when apnea has been induced by remifentanil, caffeine is able to restore the respiratory rate. The authors present the management of a respiratory impaired patient scheduled for a therapeutic colonoscopy. Our sedation was focused on the match between remifentanil in target controlled infusion and intravenous caffeine, like an “expresso to wake-up” the respiratory drive.

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Dose-dependent Respiratory Depression by Remifentanil in the Rabbit Parabrachial Nucleus/Kölliker–Fuse Complex and Pre-Bötzinger Complex

Anesthesiology ◽

10.1097/aln.0000000000003886 ◽

2021 ◽

Author(s):

Barbara Palkovic ◽

Jennifer J. Callison ◽

Vitaliy Marchenko ◽

Eckehard A. E. Stuth ◽

Edward J. Zuperku ◽

...

Keyword(s):

Respiratory Rate ◽

Respiratory Depression ◽

Receptor Agonist ◽

Parabrachial Nucleus ◽

Respiratory Drive ◽

Remifentanil Infusion ◽

Opioid Receptor Agonist ◽

Bötzinger Complex ◽

Dose Dependent ◽

Partial Reversal

Background Recent studies showed partial reversal of opioid-induced respiratory depression in the pre-Bötzinger complex and the parabrachial nucleus/Kölliker–Fuse complex. The hypothesis for this study was that opioid antagonism in the parabrachial nucleus/Kölliker–Fuse complex plus pre-Bötzinger complex completely reverses respiratory depression from clinically relevant opioid concentrations. Methods Experiments were performed in 48 adult, artificially ventilated, decerebrate rabbits. The authors decreased baseline respiratory rate ~50% with intravenous, “analgesic” remifentanil infusion or produced apnea with remifentanil boluses and investigated the reversal with naloxone microinjections (1 mM, 700 nl) into the Kölliker–Fuse nucleus, parabrachial nucleus, and pre-Bötzinger complex. In another group of animals, naloxone was injected only into the pre-Bötzinger complex to determine whether prior parabrachial nucleus/Kölliker–Fuse complex injection impacted the naloxone effect. Last, the µ-opioid receptor agonist [d-Ala,2N-MePhe,4Gly-ol]-enkephalin (100 μM, 700 nl) was injected into the parabrachial nucleus/Kölliker–Fuse complex. The data are presented as medians (25 to 75%). Results Remifentanil infusion reduced the respiratory rate from 36 (31 to 40) to 16 (15 to 21) breaths/min. Naloxone microinjections into the bilateral Kölliker–Fuse nucleus, parabrachial nucleus, and pre-Bötzinger complex increased the rate to 17 (16 to 22, n = 19, P = 0.005), 23 (19 to 29, n = 19, P < 0.001), and 25 (22 to 28) breaths/min (n = 11, P < 0.001), respectively. Naloxone injection into the parabrachial nucleus/Kölliker–Fuse complex prevented apnea in 12 of 17 animals, increasing the respiratory rate to 10 (0 to 12) breaths/min (P < 0.001); subsequent pre-Bötzinger complex injection prevented apnea in all animals (13 [10 to 19] breaths/min, n = 12, P = 0.002). Naloxone injection into the pre-Bötzinger complex alone increased the respiratory rate to 21 (15 to 26) breaths/min during analgesic concentrations (n = 10, P = 0.008) but not during apnea (0 [0 to 0] breaths/min, n = 9, P = 0.500). [d-Ala,2N-MePhe,4Gly-ol]-enkephalin injection into the parabrachial nucleus/Kölliker–Fuse complex decreased respiratory rate to 3 (2 to 6) breaths/min. Conclusions Opioid reversal in the parabrachial nucleus/Kölliker–Fuse complex plus pre-Bötzinger complex only partially reversed respiratory depression from analgesic and even less from “apneic” opioid doses. The lack of recovery pointed to opioid-induced depression of respiratory drive that determines the activity of these areas. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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The influence of osteopathic correction on the rate of various rhythms of the body

Russian Osteopathic Journal ◽

10.32885/2220-0975-2019-1-2-64-71 ◽

2019 ◽

pp. 64-71 ◽

Cited By ~ 1

Author(s):

A. E. Chernikova ◽

Yu. P. Potekhina

Keyword(s):

Heart Rate ◽

Respiratory Rate ◽

Age Groups ◽

Biomechanical Properties ◽

Dispersion Analysis ◽

The Body ◽

Body Tissues ◽

Age Related ◽

Significant Difference ◽

Before And After

Introduction. An osteopathic examination determines the rate, the amplitude and the strength of the main rhythms (cardiac, respiratory and cranial). However, there are relatively few studies in the available literature dedicated to the influence of osteopathic correction (OC) on the characteristics of these rhythms.Goal of research — to study the influence of OC on the rate characteristics of various rhythms of the human body.Materials and methods. 88 adult osteopathic patients aged from 18 to 81 years were examined, among them 30 men and 58 women. All patients received general osteopathic examination. The rate of the cranial rhythm (RCR), respiratory rate (RR) heart rate (HR), the mobility of the nervous processes (MNP) and the connective tissue mobility (CTM) were assessed before and after the OC session.Results. Since age varied greatly in the examined group, a correlation analysis of age-related changes of the assessed rhythms was carried out. Only the CTM correlated with age (r=–0,28; p<0,05) in a statistically significant way. The rank dispersion analysis of Kruskal–Wallis also showed statistically significant difference in this indicator in different age groups (p=0,043). With the increase of years, the CTM decreases gradually. After the OC, the CTM, increased in a statistically significant way (p<0,0001). The RCR varied from 5 to 12 cycles/min in the examined group, which corresponded to the norm. After the OC, the RCR has increased in a statistically significant way (p<0,0001), the MNP has also increased (p<0,0001). The initial heart rate in the subjects varied from 56 to 94 beats/min, and in 15 % it exceeded the norm. After the OC the heart rate corresponded to the norm in all patients. The heart rate and the respiratory rate significantly decreased after the OC (р<0,0001).Conclusion. The described biorhythm changes after the OC session may be indicative of the improvement of the nervous regulation, of the normalization of the autonomic balance, of the improvement of the biomechanical properties of body tissues and of the increase of their mobility. The assessed parameters can be measured quickly without any additional equipment and can be used in order to study the results of the OC.

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Effects of Music Therapy on Anxiety, Blood Pressure and Respiratory Rate in Patients Undergoing Chemotherapy

Nursing & Care Open Access Journal ◽

10.15406/ncoaj.2017.02.00053 ◽

2017 ◽

Vol 2 (6) ◽

Author(s):

Syed Imran

Keyword(s):

Blood Pressure ◽

Music Therapy ◽

Respiratory Rate

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Pulse oximetry-derived respiratory rate monitoring in pregnant women undergoing cesarean section

Minerva Anestesiologica ◽

10.23736/s0375-9393.20.14189-0 ◽

2020 ◽

Vol 86 (4) ◽

Author(s):

Hideaki Ebana ◽

Masahiro Murakawa ◽

Yoshie Noji ◽

Keisuke Yoshida ◽

Jun Honda ◽

...

Keyword(s):

Cesarean Section ◽

Pulse Oximetry ◽

Pregnant Women ◽

Respiratory Rate

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PENGARUH TINDAKAN MOBILISASI DINI TERHADAP DENYUT JANTUNG DAN FREKUENSI PERNAPASAN PADA PASIEN KRITIS DI ICU RSUD SLEMAN YOGYAKARTA

Media Ilmu Kesehatan ◽

10.30989/mik.v5i3.167 ◽

2019 ◽

Vol 5 (3) ◽

pp. 213-223

Author(s):

Muhamat Nofiyanto ◽

Tetra Saktika Adhinugraha

Keyword(s):

Heart Rate ◽

Respiratory Rate ◽

Early Mobilization ◽

Critical Conditions ◽

P Value ◽

Cardiorespiratory Function ◽

Arterial Blood ◽

Post Test ◽

Critical Patients ◽

Security Standards

Background: Patients with critical conditions in the ICU depend on a variety of tools to support their lifes. Patients’ conditions and and their unstable hemodynamic are challenges for nurses to perform mobilization. Less mobilization in critical patients can cause a variety of physical problems, one of them is cardiorespiratory function disorder. Objective: to investigate differences in heart rate (HR) and respiratory rate (RR) before, during, and immediately after early mobilization. Methods: This study employed quasi experiment with one group pre and post test design. Twenty four respondents were selected based on the criteria HR <110 / min at rest, Mean Arterial Blood Pressure between 60 to 110 mmHg, and the fraction of inspired oxygen <0.6. Early mobilization was performed to the respondents, and followed by assessments on the changes of respiratory rate and heart rate before, during, and immediately after the mobilization. Analysis of differences in this study used ANNOVA. Results: Before the early mobilization, mean RR was 22.54 and mean HR was 78.58. Immediately after the mobilization, mean RR was 23.21 and mean HR was 80.75. There was no differences in the value of RR and HR, before and immediately after the early mobilization with the p-value of 0.540 and 0.314, respectively. Conclusions: Early mobilization of critical patients is relatively safe. Nurses are expected to perform early mobilization for critical patients. However, it should be with regard to security standards and rigorous assessment of the patient's conditions. Keywords: Early mobilization, critical patients, ICU

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