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Deprecated: Implicit conversion from float 269.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Crit+Care 2020 ; 24 (1): 652 Nephropedia Template TP
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Continuous assessment of neuro-ventilatory drive during 12 h of pressure support ventilation in critically ill patients #MMPMID33218354
Di Mussi R; Spadaro S; Volta CA; Bartolomeo N; Trerotoli P; Staffieri F; Pisani L; Iannuzziello R; Dalfino L; Murgolo F; Grasso S
Crit Care 2020[Nov]; 24 (1): 652 PMID33218354show ga
INTRODUCTION: Pressure support ventilation (PSV) should allow spontaneous breathing with a "normal" neuro-ventilatory drive. Low neuro-ventilatory drive puts the patient at risk of diaphragmatic atrophy while high neuro-ventilatory drive may causes dyspnea and patient self-inflicted lung injury. We continuously assessed for 12 h the electrical activity of the diaphragm (EAdi), a close surrogate of neuro-ventilatory drive, during PSV. Our aim was to document the EAdi trend and the occurrence of periods of "Low" and/or "High" neuro-ventilatory drive during clinical application of PSV. METHOD: In 16 critically ill patients ventilated in the PSV mode for clinical reasons, inspiratory peak EAdi peak (EAdi(PEAK)), pressure time product of the trans-diaphragmatic pressure per breath and per minute (PTP(DI/b) and PTP(DI/min), respectively), breathing pattern and major asynchronies were continuously monitored for 12 h (from 8 a.m. to 8 p.m.). We identified breaths with "Normal" (EAdi(PEAK) 5-15 muV), "Low" (EAdi(PEAK) < 5 muV) and "High" (EAdi(PEAK) > 15 muV) neuro-ventilatory drive. RESULTS: Within all the analyzed breaths (177.117), the neuro-ventilatory drive, as expressed by the EAdi(PEAK), was "Low" in 50.116 breath (28%), "Normal" in 88.419 breaths (50%) and "High" in 38.582 breaths (22%). The average times spent in "Low", "Normal" and "High" class were 1.37, 3.67 and 0.55 h, respectively (p < 0.0001), with wide variations among patients. Eleven patients remained in the "Low" neuro-ventilatory drive class for more than 1 h, median 6.1 [3.9-8.5] h and 6 in the "High" neuro-ventilatory drive class, median 3.4 [2.2-7.8] h. The asynchrony index was significantly higher in the "Low" neuro-ventilatory class, mainly because of a higher number of missed efforts. CONCLUSIONS: We observed wide variations in EAdi amplitude and unevenly distributed "Low" and "High" neuro ventilatory drive periods during 12 h of PSV in critically ill patients. Further studies are needed to assess the possible clinical implications of our physiological findings.
|Aged[MESH]
|Critical Illness/therapy[MESH]
|Female[MESH]
|Humans[MESH]
|Intensive Care Units/organization & administration/statistics & numerical data[MESH]