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Raux M, Navarro-Sune X, Wattiez N, Kindler F, Le Corre M, Decavele M, Demiri S, Demoule A, Chavez M, Similowski T. Adjusting ventilator settings to relieve dyspnoea modifies brain activity in critically ill patients: an electroencephalogram pilot study. Sci Rep 2019; 9:16572. [PMID: 31719608 PMCID: PMC6851109 DOI: 10.1038/s41598-019-53152-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/29/2019] [Indexed: 12/14/2022] Open
Abstract
Dyspnoea is frequent and distressing in patients receiving mechanical ventilation, but it is often not properly evaluated by caregivers. Electroencephalographic signatures of dyspnoea have been identified experimentally in healthy subjects. We hypothesized that adjusting ventilator settings to relieve dyspnoea in MV patients would induce EEG changes. This was a first-of-its-kind observational study in a convenience population of 12 dyspnoeic, mechanically ventilated patients for whom a decision to adjust the ventilator settings was taken by the physician in charge (adjustments of pressure support, slope, or trigger). Pre- and post-ventilator adjustment electroencephalogram recordings were processed using covariance matrix statistical classifiers and pre-inspiratory potentials. The pre-ventilator adjustment median dyspnoea visual analogue scale was 3.0 (interquartile range: 2.5–4.0; minimum-maximum: 1–5) and decreased by (median) 3.0 post-ventilator adjustment. Statistical classifiers adequately detected electroencephalographic changes in 8 cases (area under the curve ≥0.7). Previously present pre-inspiratory potentials disappeared in 7 cases post-ventilator adjustment. Dyspnoea improvement was consistent with electroencephalographic changes in 9 cases. Adjusting ventilator settings to relieve dyspnoea produced detectable changes in brain activity. This paves the way for studies aimed at determining whether monitoring respiratory-related electroencephalographic activity can improve outcomes in critically ill patients under mechanical ventilation.
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Affiliation(s)
- Mathieu Raux
- Sorbonne Université, INSERM UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France.,AP-HP, Groupe Hospitalier Pitié Salpêtrière - Charles Foix, Département d'Anesthésie-Réanimation, F-75013, Paris, France
| | - Xavier Navarro-Sune
- Sorbonne Université, INSERM UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France.,Sorbonne Université, INSERM UMR 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle Épinière, Paris, France
| | - Nicolas Wattiez
- Sorbonne Université, INSERM UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France
| | - Felix Kindler
- Sorbonne Université, INSERM UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France
| | - Marine Le Corre
- AP-HP, Groupe Hospitalier Pitié Salpêtrière - Charles Foix, Département d'Anesthésie-Réanimation, F-75013, Paris, France
| | - Maxens Decavele
- Sorbonne Université, INSERM UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France.,AP-HP, Groupe Hospitalier Pitié Salpêtrière - Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, F-75013, Paris, France
| | - Suela Demiri
- Sorbonne Université, INSERM UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France.,AP-HP, Groupe Hospitalier Pitié Salpêtrière - Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, F-75013, Paris, France
| | - Alexandre Demoule
- Sorbonne Université, INSERM UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France.,AP-HP, Groupe Hospitalier Pitié Salpêtrière - Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, F-75013, Paris, France
| | - Mario Chavez
- Sorbonne Université, INSERM UMR 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle Épinière, Paris, France
| | - Thomas Similowski
- Sorbonne Université, INSERM UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France. .,AP-HP, Groupe Hospitalier Pitié Salpêtrière - Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, F-75013, Paris, France.
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Lopes P, Nunes N, Dias L, Pereira Neto G, Almeida R, Souza A, Belmonte E. Bispectral index in dogs with high intracranial pressure, anesthetized with propofol and submitted to two levels of FiO2. ARQ BRAS MED VET ZOO 2011. [DOI: 10.1590/s0102-09352011000600012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The effects of inspired oxygen fractions (FiO2) of 1 and 0.6 on bispectral index (BIS) in dogs with high intracranial pressure, submitted to a continuous rate infusion of propofol were evaluated. Eight dogs were anesthetized on two occasions, receiving, during controlled ventilation, an FiO2 = 1 (G100) or an FiO2 = 0.6 (G60). Propofol was used for induction (10mg.kg-1, IV), followed by a continuous rate infusion (0.6mg.kg-1.minute-1). After 20 minutes, a fiber-optic catheter was implanted on the surface of the right cerebral cortex to monitor the intracranial pressure, the baseline measurements of BIS values, signal quality index, suppression ratio number, electromyogram indicator, end-tidal carbon dioxide partial pressure, mean arterial pressure, intracranial pressure and cerebral perfusion pressure were taken. Then, the blood flow from the right jugular vein was interrupted in order to increase intracranial pressure and after 20 minutes additional recordings were performed at 15-minute intervals (T0, T15, T30, T45 and T60). The arterial oxygen partial pressure varied according to the changes in oxygen. For the other parameters, no significant differences were recorded. The BIS monitoring was not influenced by different FiO2.
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