Cardiorespiratory and Sympathoadrenal Responses During Weaning From Controlled Ventilation

Kennedy, Susan; Weintraub, Ronald M.; Skillman, John J.

doi:10.1097/00132586-197808000-00004

Cited by 8 publications

(14 citation statements)

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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: 73%

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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Section: Discussionsupporting

confidence: 73%

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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“…Future research must explore the connection of IL-6 with the hypothalamic-pituitaryadrenal axis and sympathetic system during the SBT and the hypothetical metabolic and hormonal implications of the rise in IL-6. As has been previously described, there is an increase in several hormonal modulators associated with stress during a SBT [21,22]. IL-6 is a major modulator of the different systems triggered during a stress response [5], so we have hypothesised that IL-6 could play a key role in the stress response associated with SBT, especially in COPD.…”

Section: Discussionmentioning

confidence: 73%

“…The patients of the T-tube group developed a greater increase in plasma insulin, cortisol, glucose and urine valine mandelic acid, showing a higher endocrine stress response than in the other weaning modes. Along the same lines, sympathoadrenal stimulation has been described as intense and usually greater in those patients who are weaned successfully, with a consequent increase in systemic catecholamine levels [22]. The imbalance between the capacity and loading conditions of the respiratory and cardiovascular system during the weaning process could entail major cardiopulmonary stress, especially in patients with limited baseline conditions, causing weaning failure, and triggering the somatic stress response and a potential increase in IL-6 [2,5].…”

Section: Discussionmentioning

confidence: 99%

The effect of spontaneous breathing on systemic interleukin-6 during ventilator weaning

Sellarés

Loureiro²,

Ferrer³

et al. 2011

Eur Respir J

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During the weaning process, spontaneous breathing trials (SBTs) involve cardiopulmonary stress for ventilated patients. As interleukin (IL)-6 is a major modulator of the stress response, we hypothesised that systemic IL-6 increases during a SBT and that this increase is more evident in SBT failure.49 SBTs of 30-min duration were performed on different mechanically ventilated patients, and classified as SBT failure or success. Blood samples were drawn before and at the end of the SBT. An additional sample was drawn 24 h later in a subset of patients (n539). Serum IL-6 levels and other inflammatory mediators commonly associated with stress were determined.IL-6 levels increased from mechanical ventilation to spontaneous breathing in all patients (p50.02) and in the chronic obstructive pulmonary disease (COPD) population (p50.05) with SBT failure compared with success, but not in non-COPD patients (p50.12). After 24 h of SBT stress, IL-6 levels decreased in patients with SBT failure (under mechanical ventilation at that point) (p50.02) and those with weaning success (p50.04). No changes were observed in the remaining inflammatory mediators.Systemic IL-6 increases during a 30-min, failed SBT, especially in COPD patients. Future studies may corroborate the different IL-6 responses among different populations who initiate weaning, together with the potential clinical implications.

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“…IVSWT interventricular septum wall thickness; LVPWT left ventricular posterior wall thickness; E and A pulsed wave Doppler early and late transmitral left ventricular filling wave velocity, respectively; A m TDI-derived peak late diastolic velocity; other abbreviations as per Tables 1 and 2 * P \ 0.05, ** P \ 0.01, 2-tailed t test for mean values return and sympathetic overstimulation [5] that may increase LV preload-afterload [7,8] and cardiac workload [6], thus impairing LV compliance; weaning-induced myocardial ischemia [9,10] or RV dysfunction [11], may also deteriorate pre-existing LV diastolic dysfunction and may increase LV filling pressures and thus provoke pulmonary edema. Notably, it was recently reported that patients with diastolic dysfunction may present impaired diastolic reserve under stressful conditions [27], and this possibly explains weaning intolerance.…”

Section: Discussionmentioning

confidence: 99%

“…After removal of positive-pressure ventilation, negative intrathoracic pressures and sympathetic overstimulation [5] may increase cardiac workload [6] and left ventricular (LV) afterload [7,8], thus impairing LV compliance; weaning-induced myocardial ischemia [9,10] or RV dysfunction [11] may also cause LV diastolic dysfunction in weaning. These phenomena, together with increased venous return [7,8], may increase LV filling pressures and provoke pulmonary edema.…”

Section: Introductionmentioning

confidence: 99%

New insights into weaning from mechanical ventilation: left ventricular diastolic dysfunction is a key player

et al. 2011

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Cardiorespiratory and Sympathoadrenal Responses During Weaning From Controlled Ventilation

Cited by 8 publications

References 0 publications

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

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

The effect of spontaneous breathing on systemic interleukin-6 during ventilator weaning

New insights into weaning from mechanical ventilation: left ventricular diastolic dysfunction is a key player

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