Cardiopulmonary coupling indices to assess weaning readiness from mechanical ventilation

Abstract

The 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.

Pulse respiration quotient as a measure sensitive to changes in dynamic behavior of cardiorespiratory coupling such as body posture and breathing regime

“…The accurate calculation of PRQ, which has been used in medicine earlier (Hildebrandt et al, 1998(Hildebrandt et al, , 2013 but not continuously calculated, could be of interest for the preparation and performance of space flights with human crew, of sportsmen and non-professional athletes, and of patients with various pathologies etc. This is in line with the research of Armañac-;Julián et al ( 2021) which pointed out that compared to HRV indices, values of cardiorespiratory coupling (CRC) were more significantly altered in patients with failed weaning, which enabled the authors to differentiate such patients as risky from those that had successful weaning (Armañac-Julián et al, 2021). Superiority of PRQ vs. HRV for the detection of the severity of cardiac pathologies was already described by Weckenmann in 1975(Weckenmann 1975.…”

Defining Predictors for Successful Mechanical Ventilation Weaning, Using a Data-mining Process and Artificial Intelligence

“…In a pilot study, the team from Barcelona did recently promote the combination of HRV analysis to traditional respiratory parameters measured to improve weaning readiness. (32) The interest of the present work relies on its originality and methodology. To the best of our knowledge, no similar study using a prospective data-warehousing project has ever been performed in the ICU environment.…”

“…The in uence of the ANS contributes to the respiratory sinus arrhythmia process and heart-rate variability (HRV) (30,31). Several studies have depicted signi cant HRV variations in patients under MV, especially while considering the weaning process, in an attempt to predict clinical evolution (32)(33)(34)(35). Transposed to mechanical ventilation weaning situations, the evaluation of these warning scores to predict the success of extubation and thus, limit the complications of prolonged mechanical ventilation or extubation failure might be of interest (36).…”

Algoritmically improved microwave radar monitors breathing more acurrate than sensorized belt

“…However, their work concentrated on assembling the device rather than on clinical trials. It should also be noted that a thorough and reliable respiratory and lung function assessment is essential before withdrawing mechanical ventilation 35 .…”