Hypercapnic Ventilatory Response in the Weaning of Patients with Prolonged Mechanical Ventilation

Lee, Chung-Shu; Chen, Ning‐Hung; Chuang, Li‐Pang; Chang, Chih Hao; Li, Lifu; Lin, Shih‐Wei; Huang, Hsiung-Ying

doi:10.1155/2017/7381424

Cited by 10 publications

(9 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…There are also substantial derangements of the hypothalamic-anterior pituitary-peripheral hormonal axes [ 14 ]. Subjects under PMV may show a lower hypercapnic ventilatory response than successfully weaned subjects [ 15 ]. A focus must be addressed also to sleep disturbances in the ICU due to the possible link between deprived sleep and development of delirium, prolonged stay in the ICU, and increased mortality [ 16 ].…”

Section: Main Textmentioning

confidence: 99%

The patient needing prolonged mechanical ventilation: a narrative review

Ambrosino

Vitacca

2018

Multidiscip Respir Med

View full text Add to dashboard Cite

BackgroundProgress in management has improved hospital mortality of patients admitted to the intensive care units, but also the prevalence of those patients needing weaning from prolonged mechanical ventilation, and of ventilator assisted individuals. The result is a number of difficult clinical and organizational problems for patients, caregivers and health services, as well as high human and financial resources consumption, despite poor long-term outcomes. An effort should be made to improve the management of these patients. This narrative review summarizes the main concepts in this field.Main bodyThere is great variability in terminology and definitions of prolonged mechanical ventilation.There have been several recent developments in the field of prolonged weaning: ventilatory strategies, use of protocols, early mobilisation and physiotherapy, specialised weaning units.There are few published data on discharge home rates, need of home mechanical ventilation, or long-term survival of these patients.Whether artificial nutritional support improves the outcome for these chronic critically ill patients, is unclear and controversial how these data are reported on the optimal time of initiation of parenteral vs enteral nutrition.There is no consensus on time of tracheostomy or decannulation. Despite several individualized, non-comparative and non-validated decannulation protocols exist, universally accepted protocols are lacking as well as randomised controlled trials on this critical issue. End of life decisions should result from appropriate communication among professionals, patients and surrogates and national legislations should give clear indications.ConclusionPresent medical training of clinicians and locations like traditional intensive care units do not appear enough to face the dramatic problems posed by these patients. The solutions cannot be reserved to professionals but must involve also families and all other stakeholders. Large multicentric, multinational studies on several aspects of management are needed.

show abstract

Section: Main Textmentioning

confidence: 99%

The patient needing prolonged mechanical ventilation: a narrative review

Ambrosino

Vitacca

2018

Multidiscip Respir Med

View full text Add to dashboard Cite

show abstract

“…Several studies have suggested the potential application of these derived parameters in assessing weaning potential, such as failure to increase O 2 pulse during exercise implies the inability to increase cardiac stroke volume, and that this is related to a poor prognosis in heart failure patients 38,39 . Other studies have shown a higher EqO 2 in patients succeeding in spontaneous breath trials, and that a decreased EqO2 implies poor ventilatory compensation in prolonged mechanically ventilated patients 40,41 . Our observations, therefore, may implicate that incorporating the analysis of gas exchange during UBT may help to better predict the long-term outcomes of these patients.…”

Section: Discussionmentioning

confidence: 93%

Kinetics of oxygen uptake during unassisted breathing trials in prolonged mechanical ventilation: a prospective pilot study

Lee

Kuo

Lin

et al. 2020

Sci Rep

View full text Add to dashboard Cite

psychological, metabolic, anemia, and nutritional problems 7. This condition may be associated with insufficient strength and endurance of respiratory muscles due to the increased respiratory mechanical load 8. In addition, the change from MV support to unassisted breathing can increase the work of breathing (WOB) 9. However, measuring WOB may not be practical in a post-acute setting due to the need for invasive placement of pressure sensors. Oxygen uptake (V O 2) assesses the global ability of oxygen intake by the respiratory system, delivery by the cardiovascular system, and use by working tissues. In physiologic studies, maximum V O 2 is traditionally used to evaluate cardiorespiratory capacity 10. For example, in cardiopulmonary exercise tests it is used to differentiate the cause of dyspnea 11 , in which an incremental external work rate is usually applied to determine whether the V O 2 is above the anaerobic threshold 12-15. The kinetics of V O 2 during exercise have also been correlated with the prognosis in patients with chronic heart failure 13,16-20. Previous studies have shown that the change in V O 2 when reducing ventilator support can be used as an alternative measurement to represent the change in WOB in patients receiving ventilator support 21. Although previous studies have evaluated associations between changes in V O 2 at different levels of ventilator support and the ability to spontaneously breathe and the outcomes of weaning 19,22,23 , few studies have investigated measurements of the kinetics of V O 2 in tracheostomized patients undergoing UBTs. Understanding the kinetics of V O 2 and associated metabolic and spirometry parameters may help clinicians to differentiate the cause of weaning failure in this last stage. Therefore, the aim of this pilot study was to investigate the kinetics of V O 2 during UBTs in patients with prolonged MV. Methods Design and setting. This prospective study was conducted from January to December 2018 at the Respira

show abstract

“…C. Lee и соавт. (2017) получили сходные результаты при изучении демографических, клинических и физиологических показателей, влияющих на процесс восстановления самостоятельного дыхания при пролонгированной ИВЛ [11]. В исследовании пациенты (n = 32) были разделены на 2 группы -с успешным результатом восстановления самостоятельного дыхания и без такового.…”

Section: Discussionunclassified

Prediction of the effectiveness of spontaneous breathing in patients with brain damage of various etiologies

Kiryachkov

Юрьевич²,

Petrova

et al. 2020

Annals RAMS

View full text Add to dashboard Cite

BACKGROUND: Long-term respiratory support is a severe disabling factor and is accompanied by a long stay of patients in intensive care units. AIMS: The analysis of the predictors of the success of disconnection from mechanical ventilation on the basis of clinical and diagnostic criteria in patients with brain damage of various etiologies. METHODS: The study included 53 patients (husband ― 28, women ― 25; cf. age 53.69 2.34) who are in 2019 with the consequences of traumatic brain injury (TBI) (n = 18; 33.9%); consequences of acute cerebrovascular accident (n = 24; 45.3%); the effects of anoxic brain damage (n = 3; 5.7%); consequences of subarachnoid hemorrhage (n = 8; 15.1%). RESULTS: The statistically significant predictor of recovery of spontaneous breathing in the 1st and 2nd groups of patients were preserved chemoreflex sensitivity (IPCS), the sensitivity and specificity of IPCS was 78.57% [95 % DI 49.295.26] and 83.3 % [95 % CI 62.695.26]. The index of peripheral chemoreflex sensitivity (IPCS) was calculated using the formula: IPCS = [RRe / RRi] [Vt(e) / Vt(i)] [VE(e) / VE(i)] [Vt(e) VE(i)], where IPCS is the index of peripheral chemoreflex sensitivity in l/min; RRi and RRe; Vt(i) and Vt(e); VE(e) and VE(i) ― respiratory rate (RR, breaths/min), tidal volume (Vt), minute ventilation (VE), (l/min) of the starting point ― (i) before carrying out a functional stress test and (e) ― during a functional test of normobaric hypoxia with SpO2 in the range of 9080 %. CONCLUSIONS: The most significant clinical parameters statistically reliably hampering the process of successful recovery of spontaneous breathing in addition to chemoreflex sensitivity are the presence of severe heart failure, pneumonia, autonomic dysfunction, level of consciousness, age, higher levels of inspiratory and expiratory pressure mounted on a respirator.

show abstract

Hypercapnic Ventilatory Response in the Weaning of Patients with Prolonged Mechanical Ventilation

Cited by 10 publications

References 29 publications

The patient needing prolonged mechanical ventilation: a narrative review

The patient needing prolonged mechanical ventilation: a narrative review

Kinetics of oxygen uptake during unassisted breathing trials in prolonged mechanical ventilation: a prospective pilot study

Prediction of the effectiveness of spontaneous breathing in patients with brain damage of various etiologies

Contact Info

Product

Resources

About