1
|
Giordano G, Alessandri F, Tosi A, Zullino V, Califano L, Petramala L, Galardo G, Pugliese F. Heart Rate Variability During Weaning from Invasive Mechanical Ventilation: A Systematic Review. J Clin Med 2024; 13:7634. [PMID: 39768558 PMCID: PMC11727775 DOI: 10.3390/jcm13247634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Revised: 12/07/2024] [Accepted: 12/13/2024] [Indexed: 01/16/2025] Open
Abstract
Background: The role of Heart Rate Variability (HRV) indices in predicting the outcome of the weaning process remains a subject of debate. The aim of this study is to investigate HRV analysis in critically ill adult patients undergoing weaning from invasive mechanical ventilation (IMV). Methods: The protocol of this systematic review was registered with PROSPERO (CRD42024485800). We searched PubMed and Scopus databases from inception till March 2023 to identify randomized controlled trials and observational studies investigating HRV analysis in critically ill adult patients undergoing weaning from invasive mechanical ventilation. Our primary outcome was to investigate HRV changes occurring during the weaning from IMV. Results: Seven studies (n = 342 patients) were included in this review. All studies reported significant changes in at least one HRV parameter. The indices Low Frequency (LF), High Frequency (HF), and LF/HF ratio seem to be the most promising in predicting the outcome of weaning with reliability. Some HRV indices showed modification in response to different ventilator settings or modalities. Conclusions: Available data report HRV modifications during the process of weaning and suggest a promising role of some HRV indices in predicting weaning outcomes in critically ill patients. Point-of-care HRV monitoring systems might help to early detect patients at risk of weaning failure.
Collapse
Affiliation(s)
- Giovanni Giordano
- Department of General and Specialistic Surgery, “Sapienza” University of Rome, 00185, Rome, Italy; (F.A.); (L.C.); (F.P.)
- Department of Emergency, Critical Care and Trauma, Policlinico Umberto I, 00161, Rome, Italy; (A.T.); (V.Z.); (L.P.); (G.G.)
| | - Francesco Alessandri
- Department of General and Specialistic Surgery, “Sapienza” University of Rome, 00185, Rome, Italy; (F.A.); (L.C.); (F.P.)
- Department of Emergency, Critical Care and Trauma, Policlinico Umberto I, 00161, Rome, Italy; (A.T.); (V.Z.); (L.P.); (G.G.)
| | - Antonella Tosi
- Department of Emergency, Critical Care and Trauma, Policlinico Umberto I, 00161, Rome, Italy; (A.T.); (V.Z.); (L.P.); (G.G.)
| | - Veronica Zullino
- Department of Emergency, Critical Care and Trauma, Policlinico Umberto I, 00161, Rome, Italy; (A.T.); (V.Z.); (L.P.); (G.G.)
| | - Leonardo Califano
- Department of General and Specialistic Surgery, “Sapienza” University of Rome, 00185, Rome, Italy; (F.A.); (L.C.); (F.P.)
- Department of Emergency, Critical Care and Trauma, Policlinico Umberto I, 00161, Rome, Italy; (A.T.); (V.Z.); (L.P.); (G.G.)
| | - Luigi Petramala
- Department of Emergency, Critical Care and Trauma, Policlinico Umberto I, 00161, Rome, Italy; (A.T.); (V.Z.); (L.P.); (G.G.)
| | - Gioacchino Galardo
- Department of Emergency, Critical Care and Trauma, Policlinico Umberto I, 00161, Rome, Italy; (A.T.); (V.Z.); (L.P.); (G.G.)
| | - Francesco Pugliese
- Department of General and Specialistic Surgery, “Sapienza” University of Rome, 00185, Rome, Italy; (F.A.); (L.C.); (F.P.)
- Department of Emergency, Critical Care and Trauma, Policlinico Umberto I, 00161, Rome, Italy; (A.T.); (V.Z.); (L.P.); (G.G.)
| |
Collapse
|
2
|
Burns KEA, Sadeghirad B, Ghadimi M, Khan J, Phoophiboon V, Trivedi V, Gomez Builes C, Giammarioli B, Lewis K, Chaudhuri D, Desai K, Friedrich JO. Comparative effectiveness of alternative spontaneous breathing trial techniques: a systematic review and network meta-analysis of randomized trials. Crit Care 2024; 28:194. [PMID: 38849936 PMCID: PMC11162018 DOI: 10.1186/s13054-024-04958-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 05/17/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND The spontaneous breathing trial (SBT) technique that best balance successful extubation with the risk for reintubation is unknown. We sought to determine the comparative efficacy and safety of alternative SBT techniques. METHODS We searched Medline, EMBASE, and the Cochrane Central Register of Controlled Trials from inception to February 2023 for randomized or quasi-randomized trials comparing SBT techniques in critically ill adults and children and reported initial SBT success, successful extubation, reintubation (primary outcomes) and mortality (ICU, hospital, most protracted; secondary outcome) rates. Two reviewers screened, reviewed full-texts, and abstracted data. We performed frequentist random-effects network meta-analysis. RESULTS We included 40 RCTs (6716 patients). Pressure Support (PS) versus T-piece SBTs was the most common comparison. Initial successful SBT rates were increased with PS [risk ratio (RR) 1.08, 95% confidence interval (CI) (1.05-1.11)], PS/automatic tube compensation (ATC) [1.12 (1.01 -1.25), high flow nasal cannulae (HFNC) [1.07 (1.00-1.13) (all moderate certainty), and ATC [RR 1.11, (1.03-1.20); low certainty] SBTs compared to T-piece SBTs. Similarly, initial successful SBT rates were increased with PS, ATC, and PS/ATC SBTs compared to continuous positive airway pressure (CPAP) SBTs. Successful extubation rates were increased with PS [RR 1.06, (1.03-1.09); high certainty], ATC [RR 1.13, (1.05-1.21); moderate certainty], and HFNC [RR 1.06, (1.02-1.11); high certainty] SBTs, compared to T-piece SBTs. There was little to no difference in reintubation rates with PS (vs. T-piece) SBTs [RR 1.05, (0.91-1.21); low certainty], but increased reintubation rates with PS [RR 2.84, (1.61-5.03); moderate certainty] and ATC [RR 2.95 (1.57-5.56); moderate certainty] SBTs compared to HFNC SBTs. CONCLUSIONS SBTs conducted with pressure augmentation (PS, ATC, PS/ATC) versus without (T-piece, CPAP) increased initial successful SBT and successful extubation rates. Although SBTs conducted with PS or ATC versus HFNC increased reintubation rates, this was not the case for PS versus T-piece SBTs.
Collapse
Affiliation(s)
- Karen E A Burns
- Departments of Critical Care Medicine and Medicine, Unity Health Toronto, St. Michael's Hospital, 30 Bond Street, 4-045 Donnelly Wing, Toronto, ON, M5B 1W8, Canada.
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
- Li Ka Shing Knowledge Institute, Unity Health Toronto, St. Michael's Hospital, Toronto, Canada.
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
| | - Behnam Sadeghirad
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Departments of Anesthesia and Medicine, McMaster University, Hamilton, Canada
| | - Maryam Ghadimi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Jeena Khan
- Departments of Critical Care Medicine and Medicine, Unity Health Toronto, St. Michael's Hospital, 30 Bond Street, 4-045 Donnelly Wing, Toronto, ON, M5B 1W8, Canada
- Royal College of Surgeons of Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Vorakamol Phoophiboon
- Departments of Critical Care Medicine and Medicine, Unity Health Toronto, St. Michael's Hospital, 30 Bond Street, 4-045 Donnelly Wing, Toronto, ON, M5B 1W8, Canada
- Division of Critical Care Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Vatsal Trivedi
- Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Canada
| | - Carolina Gomez Builes
- Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Benedetta Giammarioli
- Department of Anesthesiology & Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Kimberley Lewis
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Departments of Anesthesia and Medicine, McMaster University, Hamilton, Canada
- Department of Critical Care, St. Joseph's Healthcare, Hamilton, Canada
| | - Dipayan Chaudhuri
- Departments of Anesthesia and Medicine, McMaster University, Hamilton, Canada
- Department of Critical Care, St. Joseph's Healthcare, Hamilton, Canada
| | - Kairavi Desai
- Michael DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Jan O Friedrich
- Departments of Critical Care Medicine and Medicine, Unity Health Toronto, St. Michael's Hospital, 30 Bond Street, 4-045 Donnelly Wing, Toronto, ON, M5B 1W8, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, St. Michael's Hospital, Toronto, Canada
| |
Collapse
|
3
|
Chung WC, Sheu CC, Hung JY, Hsu TJ, Yang SH, Tsai JR. Novel mechanical ventilator weaning predictive model. Kaohsiung J Med Sci 2020; 36:841-849. [PMID: 32729992 DOI: 10.1002/kjm2.12269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/31/2020] [Accepted: 06/19/2020] [Indexed: 11/11/2022] Open
Abstract
Mechanical ventilation (MV) is a common life support system in intensive care units. Accurate identification of patients who are capable of being extubated can shorten the MV duration and potentially reduce MV-related complications. Therefore, prediction of patients who can successfully be weaned from the mechanical ventilator is an important issue. The electronic medical record system (EMRs) has been applied and developed in respiratory therapy in recent years. It can increase the quality of critical care. However, there is no perfect index available that can be used to determine successful MV weaning. Our purpose was to establish a novel model that can predict successful weaning from MV. Patients' information was collected from the Kaohsiung Medical University Hospital respiratory therapy EMRs. In this retrospective study, we collected basic information, classic weaning index, and respiratory parameters during spontaneous breathing trials of patients eligible for extubation. According to the results of extubation, patients were divided into successful extubation and extubation failure groups. This retrospective cohort study included 169 patients. Statistical analysis revealed successful extubation predictors, including sex; height; oxygen saturation; Glasgow Coma Scale; Acute Physiology and Chronic Health Evaluation II score; pulmonary disease history; and the first, 30th, 60th, and 90th minute respiratory parameters. We built a predictive model based on these predictors. The area under the curve of this model was 0.889. We established a model for predicting the successful extubation. This model was novel to combine with serial weaning parameters and thus can help intensivists to make extubation decisions easily.
Collapse
Affiliation(s)
- Wei-Chan Chung
- Division of Respiratory Therapy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Chau-Chyun Sheu
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jen-Yu Hung
- Division of Pulmonary and Critical Care Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tuan-Jung Hsu
- Division of Respiratory Therapy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ssu-Han Yang
- Division of Respiratory Therapy, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Jong-Rung Tsai
- Division of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Cijin Hospital, Kaohsiung, Taiwan
| |
Collapse
|