Respiratory sinus arrhythmia is reversed during positive pressure ventilation

Yli‐Hankala, Arvi; Porkkala, Timo; Kaukinen, S.; Häkkinen, V.; Jäntti, V.

doi:10.1111/j.1748-1716.1991.tb09097.x

Cited by 43 publications

(33 citation statements)

References 13 publications

(7 reference statements)

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“…This result was surprising, because the patients were receiving positive pressure ventilation during sevoflurane anesthesia and our results were not in accord with Hankala et al 7 who showed that RSA is reversed during positive pressure ventilation. They demonstrated that the typical phase relationship of RSA is a decrease in inspiration and an increase in expiration, which is reversed in awake, actively breathing subjects.…”

Section: Discussioncontrasting

confidence: 56%

“…Fujisato et al 6 demonstrated that the Mayer wave related sinus arrhythmia reflecting sympathetic activity was less affected by sevoflurane than by halothane or isoflurane. Interestingly, Hankala et al 7 reported that considerable RSA was caused by ventilation frequency of6.min a (i.e. 0.1Hz), which is relevant to sympathetic RSA control, even during deep anesthesia.…”

Section: Discussionmentioning

confidence: 99%

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Transfer function analysis of the circulation in patients undergoing sevoflurane anesthesia

Fujiwara

Komatsu

Kimura

et al. 1999

Can J Anesth/J Can Anesth

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Purpose: The effects of sevoflurane anesthesia on the interactions between heart rate, blood pressure and respiration were assessed using transfer function analysis. Methods: Nine ASA I or 2 patients undergoing elective surgery were involved. They were paralysed and their lungs were mechanically ventilated during sevoflurane anesthesia. Instantaneous heart rate (IHR) from electrocardiogram, instantaneous lung volume (ILV) by respiratory inductive plethysmography and mean blood pressure (MBP) by arterial tonometry were obtained during conscious state, and I MAC and 2MAC of sevoflurane anesthesia. Transfer function analysis for the relationships between ILV and IHR, ILV and MBP, MBP and IHR were made for five minute periods during which the respiratory rate was varied in a standardized fashion. Resu]ts: In awake patients transfer magnitudes for the relationships between ILV and IHR and between MBP and IHR in the 0.04-0.5Hz frequency band were 8.9 -+ 7.7 bpml -i and 0.95 ---0.44 bpm.mmHg -I respectively. Sevoflurane 2MAC decreased these values to 1.2 + 0.7 (P = 0.014) and 0.26 ---0.14 (P < 0.0 I) respectively, but phases were not affected. Neither transfer magnitudes nor phases between ILV and MBP were affected during sevoflurane anesthesia. Coherence for the relationships between ILV and IHR and between MBP and IHR were decreased during I MAC sevoflurane anesthesia but not affected during 2MAC sevoflurane anesthesia. Conc.Jusion.~: The interactions between heart rate, blood pressure and respiration were altered by sevoflurane anesthesia. These findings could be explained by the attenuation of autonomic nervous system activity, Objectif: l~valuer les effets de ranesth&ie avec du sEvoflurane sur les interactions entre la frEquence cardiaque, la tension art&ielle et la respiration par l'analyse de la fonction de transfert. M&hodr : Neuf patients de classe I ou II ASA, devant subir une intervention Elective, ont EtE recrut&. On les a insensibilis& et places sous ventilation m&anique pendant l'anesth&ie au sEvoflurane. On a obtenu la frEquence cardiaque instantanEe (FCI), de rElectrocardiogramme; le volume pulmonaire instantanE 01PI), de la pl&hysmo-graphie respiratoire inductive; la tension art&ielle moyenne (TAM), de la tonomEtrie art&ielle, ~ r&at de conscience, puis ~. I CAM et ~ 2CAM de sEvoflurane, l'analyse de la fonction de transfert a EtE faite pour &udier les relations entre le VPI et la FCI, le VPI et la TAM, la TAM et la FCI pour des p~riodes de cinq minutes durant lesquelles le rythme respiratoire Etait modifiE d'une fa~on standard. RE~sultats : Chez les patients EveillEs, rampleur du transfert pour les relations entre le VPI et la FCI, et entre la TAM et la FCl, selon la bande de frEquences de 0,04-0,5 Hz a EtE de 8,9 ___ 7,7 bpm'l-' et de 0,95 __+ 0,44 bpm.mmHg -I respectivement. Sous une concentration de 2CAM de sEvoflurane, ces valeurs ont baissE ~ 1,2 _ 0,7 (P = 0,014) et ~ 0,26 ___ 0, 14 (P < 0,01) respectivement, mais les phases front pas changE. Ni rampleur du transfert, ni les phases entre le VPI ...

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Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Transfer function analysis of the circulation in patients undergoing sevoflurane anesthesia

Fujiwara

Komatsu

Kimura

et al. 1999

Can J Anesth/J Can Anesth

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“…It still can be seen that a fluctuation in heart rate occurs synchronously with artificial and spontaneous ventilation. The influence of artificial ventilation on heart rate is not obviously reversed as found by Yli-Hankala et al (18). This might be ascribed to the less appropriate respiration measurement (impedance instead of tracheal pressure measurement), but might also be due to entrainment of the central respiratory activity by artificial ventilation.…”

Section: Resultsmentioning

confidence: 62%

“…Thus, the central interaction between respiratory and cardiovascular centers is not detectable during involuntary breathing. Yli-Hankala et al (18) described a reversed RSA in artificially ventilated adults during anesthesia. They found a heart rate decrease during mechanical lung inflation in contrast to the centrally initiated increase in heart rate related to spontaneous inspiration.…”

Section: Resultsmentioning

confidence: 99%

The Influence of Artificial Ventilation on Heart Rate Variability in Very Preterm Infants

et al. 1995

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To study the influence of artificial ventilation rate on neonatal heart rate variability (HRV), ECG and respiratory impedance curves were recorded four times a day in 20 preterm infants (<33 wk) during the first 3 d after birth while the infants were ventilated at a wide range of ventilator rates. The contents of selected frequency bands within the R-R interval power spectrum were calculated for 3-min periods. Respiratory distress syndrome severity was assessed at each measurement. Respiratory sinus arrhythmia (RSA) induced by the ventilator appeared to mimic spontaneous RSA. As in spontaneous respiration, the amount of RSA (power in a frequency band around the respiratory rate) increases as the ventilation rate decreases. This phenomenon is most probably due to entrainment with baroreflex-related fluctuations in the heart rate. Although the artificial ventilation rate influences RSA and thus high-frequency HRV, an increase in respiratory distress syndrome severity results in a decrease in low-frequency HRV. Thus, the attenuation of low-frequency HRV by respiratory distress syndrome is not likely to be due to artificial ventilation. (Pediatr Res 37: 124-130, 1995) Abbreviations aRSA, artificial respiratory sinus arrhythmia aVR, artificial ventilation rate HF, high-frequency HRV, heart rate variability LF, low-frequency RDS, respiratory distress syndrome RSA, respiratory sinus arrhythmia VLF, very LF HRV, i.e. the variation in beat-to-beat R-R interval length, is influenced by maturational (e.g. gestational age), physiologic (e.g. respiration), and clinical factors (1, 2). HRV can be assessed by spectral analysis to study the frequency-specific oscillations in the heart rate signal. In the newborn, the following heart rate oscillations may be present. HF oscillations have a frequency equal to the respiratory rate and are known as RSA. LF oscillations are due to intrinsic oscillations of the baroreceptor reflex loop with a frequency of 0.07 Hz (3). A second kind of LF oscillation may result from periodic fluctuations in respiratory depth or tidal volume (4). The last type of HRV features VLF oscillations with a frequency below 0.04 Hz. These are ascribed to thermoregulation. H F oscillations are mediated by the parasympathetic system. LF and VLF oscillations are mediated by both the sympathetic and parasympathetic systems (5). Thus, studying neonatal HRV can give an insight into the maturation of the autonomic nervous system.In newborns suffering from RDS, HRV appears to be atten- HRV returns to normal (2). Several explanations have been proposed for this reversible effect of RDS on HRV. For instance, it has been ascribed to transient depression of the medulla oblongata by hypercarbia (2). The possible influence of artificial ventilation as such on neonatal HRV has not been taken into account in studies regarding the influence of RDS. For the correct interpretation of HRV in infants with RDS, insight into the effect of artificial ventilation on HRV is needed. This influence cannot be studied by simply comparing...

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“…We were able to maintain constant frequency, V T and P ET,CO 2 , thereby eliminating variation in these parameters as a source of variability in RSA (Hayano et al 1994;Sasano et al 2002) and dead space ventilation. Our protocol was carried out in spontaneously breathing subjects, rather than using positive pressure ventilation, which reverses the RSA pattern (Yli-Hankala et al 1991), as a confounding factor. Our results are consistent with previous reports (Hayano et al 1996;Hayano & Yasuma, 2003 …”

Section: Discussionmentioning

confidence: 99%

Vagal nerve activity contributes to improve the efficiency of pulmonary gas exchange in hypoxic humans

Ito¹,

Sasano²,

Sasano³

et al. 2006

Experimental Physiology

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The aim of this study was to test our hypothesis that both phasic cardiac vagal activity and tonic pulmonary vagal activity, estimated as respiratory sinus arrhythmia (RSA) and anatomical dead space volume, respectively, contribute to improve the efficiency of pulmonary gas exchange in humans. We examined the effect of blocking vagal nerve activity with atropine on pulmonary gas exchange. Ten healthy volunteers inhaled hypoxic gas with constant tidal volume and respiratory frequency through a respiratory circuit with a respiratory analyser. Arterial partial pressure of O 2 (P aO 2 ) and arterial oxygen saturation (S pO 2 ) were measured, and alveolar-toarterial P O 2 difference (D A−aO 2 ) was calculated. Anatomical dead space (V D,an ), alveolar dead space (V D,alv ) and the ratio of physiological dead space to tidal volume (V D,phys /V T ) were measured. Electrocardiogram was recorded, and the amplitude of R-R interval variability in the high-frequency component (RRIHF) was utilized as an index of RSA magnitude. These parameters of pulmonary function were measured before and after administration of atropine (0.02 mg kg −1 ). Decreased RRIHF (P < 0.01) was accompanied by decreases in P aO 2 and S pO 2 (P < 0.05 and P < 0.01, respectively) and an increase in D A−aO 2 (P < 0.05). Anatomical dead space, V D,alv and V D,phys /V T increased (P < 0.01, P < 0.05 and P < 0.01, respectively) after atropine administration. The blockade of the vagal nerve with atropine resulted in an increase in V D,an and V D,alv and a deterioration of pulmonary oxygenation, accompanied by attenuation of RSA. Our findings suggest that both phasic cardiac and tonic pulmonary vagal nerve activity contribute to improve the efficiency of pulmonary gas exchange in hypoxic conscious humans. The cardiovascular system mediates the interchange of oxygen and carbon dioxide between the lungs and the tissues (Richter et al. 1991;Coleridge et al. 1997). A high degree of co-ordination between the cardiovascular and respiratory system has been required from the earliest stages of vertebrate evolution (Taylor et al. 1999). The vagal nervous system is involved in the function of both systems and may play a role in co-ordinating their activity. Phasic activity of the cardiac vagal outflow is closely linked to respiration and produces respiratory sinus arrhythmia (RSA), which causes increases in heart rate during inspiration and decreases during expiration. It may improve pulmonary gas exchange by matching pulmonary capillary perfusion to alveolar ventilation during each respiratory cycle (Hayano et al. 1996;Hayano & Yasuma, 2003). Hayano et al. (1996) demonstrated that in vagotomized dogs whose heart rates were controlled with a pacemaker, artificially generated RSA improved the efficiency of gas exchange as a result of decreasing the ratio of physiological dead space to tidal volume (V D,phys /V T ) and the fraction of intrapulmonary shunt. Giardino et al. (2003) also reported that the magnitude of RSA was associated with efficiency of pulmonary gas exch...

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Respiratory sinus arrhythmia is reversed during positive pressure ventilation

Cited by 43 publications

References 13 publications

Transfer function analysis of the circulation in patients undergoing sevoflurane anesthesia

Transfer function analysis of the circulation in patients undergoing sevoflurane anesthesia

The Influence of Artificial Ventilation on Heart Rate Variability in Very Preterm Infants

Vagal nerve activity contributes to improve the efficiency of pulmonary gas exchange in hypoxic humans

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