In COPD patients on prolonged mechanical ventilation heart rate variability during the T-piece trial is better after pressure support plus PEEP: A pilot physiological study

Michele Vitacca, Simonetta Scalvini, Maurizio Volterrani, Enrico Maria Clini, Mara Paneroni, Amerigo Giordano, Nicolino Ambrosino

Research output: Contribution to journalArticle

Abstract

Objectives: To evaluate heart rate variability (HRV), hemodynamics, mechanics, dyspnea and blood gases following different mechanical ventilation (MV) settings. Background: No study has evaluated physiological changes during T-piece trials following different MV settings. Methods: In 8 COPD patients on prolonged MV we applied in random order two MV settings: i) pressure support (PS) 20cmH2O+positive end-expiratory pressure (PEEP) 0cmH2O (setting-1) and ii) PS 15cmH2O+PEEP 5cmH2O (setting-2), each followed by a 30min T-piece trial. Results: Setting-1 induced greater minute ventilation, tidal volume/inspiratory time and lower pulmonary artery occlusion pressure; setting-2 reduced intrinsic PEEP. Mechanics and hemodynamics data did not differ, but all HRV time domain indices were reduced only after setting-1, suggesting a decreased parasympathetic and increased sympathetic cardiac modulation. Conclusions: The T-piece trial following setting-2 seems less stressful on neural control of HRV. Future studies on T-piece trials should consider the residual effect of the MV setting.

Original languageEnglish
Pages (from-to)420-426
Number of pages7
JournalHeart and Lung: Journal of Acute and Critical Care
Volume43
Issue number5
DOIs
Publication statusPublished - 2014

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Critical Care and Intensive Care Medicine
  • Pulmonary and Respiratory Medicine

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