Plasma catecholamines and oxygen consumption during weaning from mechanical ventilation

Oh, T. E.; Bhatt, S. B.; Lin, E.S.; Hutchinson, R.; Low, J. M.

doi:10.1007/bf01709877

Cited by 62 publications

(29 citation statements)

References 20 publications

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“…This hypothesis was also supported by nirV9O 2 evolution, an estimation of local oxygen consumption that corrects DeO 2 for the local haemoglobin content [20]. This finding might reflect increased sympathetic outflow trying to compensate for the inadequate cardiovascular response, as supported by other studies that showed a significant increase in plasma catecholamine levels during WT, especially in failure to wean patients [28][29][30].…”

Section: Discussionsupporting

confidence: 54%

Thenar oxygen saturation during weaning from mechanical ventilation: an observational study

Gruartmoner

Mesquida

Masip

et al. 2013

European Respiratory Journal

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Our aim was to determine whether thenar tissue oxygen saturation (StO 2 ), measured by noninvasive near-infrared spectroscopy, and its changes derived from an ischaemic challenge are associated with weaning outcome.Our study comprised a prospective observational study in a 26-bed medical-surgical intensive care unit. Patients receiving mechanical ventilation for .48 h, and considered ready to wean by their physicians underwent a 30-min weaning trial. StO 2 was measured continuously on the thenar eminence. A transient vascular occlusion test was performed prior to and at the end of the 30-min weaning trial, in order to obtain StO 2 deoxygenation and reoxygenation rates, and estimated local oxygen consumption. 37 patients were studied. Patients were classified as weaning success (n524) or weaning failure (n513). No significant demographic, respiratory or haemodynamic differences were observed between the groups at inclusion. Patients who failed the overall weaning process showed a significant increase in deoxygenation and in local oxygen consumption from baseline to 30 min of weaning trial, whereas no significant changes were observed in the weaning success group.Failure to wean from mechanical ventilation was associated with higher relative increases in deoxygenation after 30 min of spontaneous ventilation. @ERSpublications Failure to wean from mechanical ventilation is associated with increases in deoxygenation after spontaneous ventilation

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Section: Discussionsupporting

confidence: 54%

Thenar oxygen saturation during weaning from mechanical ventilation: an observational study

Gruartmoner

Mesquida

Masip

et al. 2013

European Respiratory Journal

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“…However, the higher fC and lower SBP noted in these patients are probably associated with an increase in catecholamine release. Increased sympathetic activity during weaning has been related [5,19,23,24] to plasma noradrenaline levels significantly higher in patients in whom weaning failed [23]. In the current study, this assumption is supported by the apparently enhanced fC and SBP in patients with weaning failure.…”

Section: Discussionsupporting

confidence: 75%

Gastric intramucosal pH: an indicator of weaning outcome from mechanical ventilation in COPD patients

Bouachour¹,

Guiraud²,

Jp³

et al. 1996

Eur Respir J

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G Ga as st tr ri ic c i in nt tr ra am mu uc co os sa al l p pH H: : a an n i in nd di ic ca at to or r o of f w we ea an ni in ng g o ou ut tc co om me e f fr ro om m m me ec ch ha an ni ic ca al l v ve en nt ti il la at ti io on n i in n C CO OP PD D p pa at ti ie en nt ts s G. Bouachour, M-P. Guiraud, J-P. Gouello, P-M. Roy, P. Alquier ABSTRACT: The aim of this study was to determine whether gastric intramucosal pH (pHim) and/or gastric intramucosal carbon dioxide tension (PCO 2 ,im) measured by tonometry can be used to predict the success of weaning in chronic obstructive pulmonary disease (COPD) patients. Twenty six consecutive COPD patients, undergoing mechanical ventilation for acute respiratory failure and satisfying the criteria of weaning from mechanical ventilation with nasogastric tonometer in place, were studied. Arterial blood gas values and PCO 2 ,im were measured 24 h before (H-24), just before (H0), and after 20 min of a weaning trial on T-piece (H20min). Weaning failure was defined as the development of respiratory distress and/or arterial blood gas impairments during the first 2 h of spontaneous breathing on T-piece, or reintubation within 24 h after extubation.Between the weaning failure (n=6) and weaning success (n=20) groups, there were no differences in blood gas analysis readings at H-24 and H0 before the weaning period, age, Simplified Acute Physiology Score (SAPS) on admission, SAPS on the day of weaning trial, and duration of ventilation. Clinical status, tonometric and arterial gasometric data were similar at H-24 and H0 in all patients. During mechanical ventilation, pHim was ≤7.30 in patients who failed weaning and >7.30 in patients who were successfully weaned (p<0.001; 100% sensitivity and specificity). The threshold value for PCO 2 ,im of 8.0 kPa (60 mmHg) represents a clear demarcation with respect to outcome before the weaning trial. PCO 2 ,im values during mechanical ventilation are significantly different (p<0.001) between patients who were successfully weaned and those who were not (6.9±0.9 vs 9.9±1.1 kPa (51.9±6.7 vs 74.3±8.0 mmHg, respectively)). At H20min, pHim and PCO 2 ,im were still statistically different between the weaning failure and the weaning success group.We conclude that measurement of gastric intramucosal pH (or gastric intramucosal carbon dioxide tension) represents a simple and accurate index to predict weaning outcome in chronic obstructive pulmonary disease patients before attempting weaning.

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“…The mean plasma norepinephrine levels significantly increased from 1.13 ± 0.55 ng/ml on CMV to 1.85 ± 0.96 ng/ml during spontaneous breathing, and epinephrine levels significantly increased from 0.10 ± 0.05 to 0.20 ± 0.13 ng/ml, respectively. Similarly, in another study by Oh and coworkers 21 , increases in plasma catecholamine levels during weaning trials were found. Mean plasma epinephrine levels significantly increased from 136 pg/ml on CMV to 508 pg/ml during weaning, and norepinephrine levels increased from 483 to 1143 pg/ml, respectively.…”

supporting

confidence: 55%

Neurormonal and inflammatory responses during weaning trials from mechanical ventilation

Routsi¹,

Papas²,

Zakynthinos³

2013

OA Critical Care

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IntroductionWeaning from mechanical ventilation is usually accomplished with spontaneous breathing trials. The discontinuation of mechanical ventilation and the resumption of spontaneous breathing may increase oxygen demands, and patients, mainly those with limited cardiorespiratory reserve, are subjected to pulmonary and cardiovascular stress. In addition, emotional distress due to agitation after interruption of sedative drugs, anxiety and other sources of discomfort potentially contributes to pulmonary and cardiovascular stress. There is evidence of metabolic and endocrine stress response expressed as an increase in oxygen consumption and plasma concentration of catecholamines and other hormones involved in the stress system activation, in patients during the weaning process from mechanical ventilation, especially during failing weaning attempts. Furthermore, extrapolating from both physical exercise and inspiratory resistive breathing data, there is evidence of immune response expressed as an increase of proinflammatory cytokine blood levels. The purpose of this review is to summarise the published information about neurormonal and inflammatory stress response during weaning from mechanical ventilation. Neurormonal and inflammatory responses during weaning trials from mechanical ventilationC Routsi*, V Papas, S Zakynthinos ConclusionThe stress response during weaning trials from mechanical ventilation has not been studied enough. Nevertheless, there is evidence that the process of weaning from mechanical ventilation incorporates hormonal, inflammatory and neuroendocrine responses, indicating that weaning might prove physically and psychologically stressful. Further studies should evaluate this stress response more thoroughly for better management of these patients.

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Plasma catecholamines and oxygen consumption during weaning from mechanical ventilation

Cited by 62 publications

References 20 publications

Thenar oxygen saturation during weaning from mechanical ventilation: an observational study

Thenar oxygen saturation during weaning from mechanical ventilation: an observational study

Gastric intramucosal pH: an indicator of weaning outcome from mechanical ventilation in COPD patients

Neurormonal and inflammatory responses during weaning trials from mechanical ventilation

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