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da Silva RB, Neves VR, Montarroyos UR, Silveira MS, Sobral Filho DC. Heart rate variability as a predictor of mechanical ventilation weaning outcomes. Heart Lung 2023; 59:33-36. [PMID: 36706686 DOI: 10.1016/j.hrtlng.2023.01.007] [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: 09/11/2022] [Revised: 01/04/2023] [Accepted: 01/15/2023] [Indexed: 01/27/2023]
Abstract
BACKGROUND Delays in the mechanical ventilation (MV) weaning process increase mortality. The spontaneous breathing test is the gold standard to assess weaning and extubation success, although it has approximately 85% accuracy. Studies have demonstrated a correlation between decreased heart rate variability (HRV) and weaning failure. OBJECTIVES To assess the usefulness of HRV as a predictor of MV weaning outcomes. METHODS Cross-sectional analytical study in adults of both sexes on MV in intensive care unit (ICU) stay. Patients were divided into weaning success and failure groups. Clinical data were collected, and HRV records were obtained with a heart rate monitor. RESULTS The study included 68 individuals - 91.1% in the weaning success group and 8.9% in the failure group. All HRV indices analyzed in both groups were lower than the reference values. No statistical difference was found in the mean RR interval (RRi), the standard deviation of the NN interval (SDNN), and the square root of the mean squared differences of successive NN intervals (RMSSD) between the groups. The weaning failure group had a significant increase in LF (41 vs. 69.4) and LF/HF ratio (0.685 vs. 2.6) and a significant decrease in HF (58.85 vs. 30.2). CONCLUSIONS HRV measure with spectral analysis can be a good predictor of MV weaning failure. Integrating this assessment tool in ICU to predict weaning outcomes could provide more precise prognoses and more adequate assistance quality.
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Affiliation(s)
- Renata Baltar da Silva
- Postgraduation Program in Health Sciences (PPGCS), University of Pernambuco (UPE), Recife, PE, Brazil; Clinics Hospital of the Federal University of Pernambuco (HC-UFPE) - Brazilian Hospital Services Company (EBSERH), Recife, PE, Brazil; Agamenon Magalhães Hospital (HAM), UPE, Recife, PE, Brazil.
| | - Victor Ribeiro Neves
- Postgraduation Program in Functional Rehabilitation and Performance (PPGRDF), UPE, Petrolina, PE, Brazil.
| | - Ulisses Ramos Montarroyos
- Postgraduation Program in Health Sciences (PPGCS), University of Pernambuco (UPE), Recife, PE, Brazil.
| | - Matheus Sobral Silveira
- Postgraduation Program in Functional Rehabilitation and Performance (PPGRDF), UPE, Petrolina, PE, Brazil.
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Armañac-Julián P, Hernando D, Lázaro J, de Haro C, Magrans R, Morales J, Moeyersons J, Sarlabous L, López-Aguilar J, Subirà C, Fernández R, Orini M, Laguna P, Varon C, Gil E, Bailón R, Blanch L. Cardiopulmonary coupling indices to assess weaning readiness from mechanical ventilation. Sci Rep 2021; 11:16014. [PMID: 34362950 PMCID: PMC8346488 DOI: 10.1038/s41598-021-95282-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 07/20/2021] [Indexed: 02/07/2023] Open
Abstract
The ideal moment to withdraw respiratory supply of patients under Mechanical Ventilation at Intensive Care Units (ICU), is not easy to be determined for clinicians. Although the Spontaneous Breathing Trial (SBT) provides a measure of the patients' readiness, there is still around 15-20% of predictive failure rate. This work is a proof of concept focused on adding new value to the prediction of the weaning outcome. Heart Rate Variability (HRV) and Cardiopulmonary Coupling (CPC) methods are evaluated as new complementary estimates to assess weaning readiness. The CPC is related to how the mechanisms regulating respiration and cardiac pumping are working simultaneously, and it is defined from HRV in combination with respiratory information. Three different techniques are used to estimate the CPC, including Time-Frequency Coherence, Dynamic Mutual Information and Orthogonal Subspace Projections. The cohort study includes 22 patients in pressure support ventilation, ready to undergo the SBT, analysed in the 24 h previous to the SBT. Of these, 13 had a successful weaning and 9 failed the SBT or needed reintubation -being both considered as failed weaning. Results illustrate that traditional variables such as heart rate, respiratory frequency, and the parameters derived from HRV do not differ in patients with successful or failed weaning. Results revealed that HRV parameters can vary considerably depending on the time at which they are measured. This fact could be attributed to circadian rhythms, having a strong influence on HRV values. On the contrary, significant statistical differences are found in the proposed CPC parameters when comparing the values of the two groups, and throughout the whole recordings. In addition, differences are greater at night, probably because patients with failed weaning might be experiencing more respiratory episodes, e.g. apneas during the night, which is directly related to a reduced respiratory sinus arrhythmia. Therefore, results suggest that the traditional measures could be used in combination with the proposed CPC biomarkers to improve weaning readiness.
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Affiliation(s)
- Pablo Armañac-Julián
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) group at the Aragón Institute of Engineering Research (I3A), IIS Aragón, University of Zaragoza, Zaragoza, Spain.
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Instituto de Salud Carlos III, Madrid, Spain.
| | - David Hernando
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) group at the Aragón Institute of Engineering Research (I3A), IIS Aragón, University of Zaragoza, Zaragoza, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Jesús Lázaro
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) group at the Aragón Institute of Engineering Research (I3A), IIS Aragón, University of Zaragoza, Zaragoza, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Candelaria de Haro
- Critical Care Center, Hospital Universitari Parc Taulí, Institut d'Investigació Parc Taulí I3PT, Universitat Autónoma de Barcelona, Sabadell, Spain
- CIBER de Enfermedades Respiratorias (CIBER-ES), Instituto de Salud Carlos III, Madrid, Spain
| | | | - John Morales
- Department of Electrical Engineering-ESAT, STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
| | - Jonathan Moeyersons
- Department of Electrical Engineering-ESAT, STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
| | - Leonardo Sarlabous
- Critical Care Center, Hospital Universitari Parc Taulí, Institut d'Investigació Parc Taulí I3PT, Universitat Autónoma de Barcelona, Sabadell, Spain
| | - Josefina López-Aguilar
- Critical Care Center, Hospital Universitari Parc Taulí, Institut d'Investigació Parc Taulí I3PT, Universitat Autónoma de Barcelona, Sabadell, Spain
- CIBER de Enfermedades Respiratorias (CIBER-ES), Instituto de Salud Carlos III, Madrid, Spain
| | - Carles Subirà
- Department of Intensive Care, Fundació Althaia, Universitat Internacional de Catalunya, Manresa, Spain
| | - Rafael Fernández
- CIBER de Enfermedades Respiratorias (CIBER-ES), Instituto de Salud Carlos III, Madrid, Spain
- Department of Intensive Care, Fundació Althaia, Universitat Internacional de Catalunya, Manresa, Spain
| | - Michele Orini
- Institute of Cardiovascular Science, University College London, London, UK
- Barts Heart Centre, St Bartholomews Hospital, University College London, London, UK
| | - Pablo Laguna
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) group at the Aragón Institute of Engineering Research (I3A), IIS Aragón, University of Zaragoza, Zaragoza, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Carolina Varon
- Department of Electrical Engineering-ESAT, STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Leuven, Belgium
- Circuits and Systems (CAS) group, Delft University of Technology, Delft, The Netherlands
| | - Eduardo Gil
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) group at the Aragón Institute of Engineering Research (I3A), IIS Aragón, University of Zaragoza, Zaragoza, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Raquel Bailón
- Biomedical Signal Interpretation and Computational Simulation (BSICoS) group at the Aragón Institute of Engineering Research (I3A), IIS Aragón, University of Zaragoza, Zaragoza, Spain
- CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Lluís Blanch
- Critical Care Center, Hospital Universitari Parc Taulí, Institut d'Investigació Parc Taulí I3PT, Universitat Autónoma de Barcelona, Sabadell, Spain
- CIBER de Enfermedades Respiratorias (CIBER-ES), Instituto de Salud Carlos III, Madrid, Spain
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Khandoker AH, Al-Angari HM, Marzbanrad F, Kimura Y. Investigating myocardial performance in normal and sick fetuses by abdominal Doppler signal derived indices. Curr Res Physiol 2021; 4:29-38. [PMID: 34746824 PMCID: PMC8562139 DOI: 10.1016/j.crphys.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/20/2021] [Accepted: 02/01/2021] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Fetal myocardial performance indices are applied to assess aspects of systolic and diastolic function in developing fetal heart. The aim of this study was to determine normal values of Tei Index (TI) and modified TI (KI) for systolic and diastolic performance in early (<30 weeks), Mid (30-35 weeks) and late (36-41 weeks) relating to both normal fetuses as well as fetuses carrying a variety of fetal abnormalities, which do not call for precise anatomic imaging. MATERIAL AND METHODS Fetal Electrocardiogram Signals (FES) and Doppler Ultrasound Signal (DUS) were simultaneously documented from 55 normal and 25 abnormal fetuses with a variety of abnormalities including Congenital Heart Diseases (CHDs) and a variety of non-CHDs. The isovolumic contraction time (ICT), isovolumic relaxation time (IRT), ventricular ejection time (VET) and ventricular filling time (VFT) were estimated from continuous DUS signals by a hybrid of Hidden Markov and Support Vector Machine based automated model. The TI and the KI were calculated by using the formula (ICT + IRT)/VET and (ICT + IRT)/VFT respectively. RESULTS The TI was not found to show any significant change from early to late fetuses, nor between normal and abnormal cases. On the other hand, KI was shown to significantly decline in values from early to late normal cases and from normal to abnormal groups. Significant correlation (r = -0.36; p < 0.01) of gestational ages with only KI (not TI) was found in this study. CONCLUSION Modified TI (KI) may be a useful index to monitor the normal development of fetal myocardial function and identify fetuses with a variety of CHD and non-CHD cases.
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Affiliation(s)
- Ahsan H. Khandoker
- Healthcare Engineering Innovation Center (HEIC), Department of Biomedical Engineering Department, Khalifa University, PO Box 127788, Abu Dhabi, United Arab Emirates
| | - Haitham M. Al-Angari
- Healthcare Engineering Innovation Center (HEIC), Department of Biomedical Engineering Department, Khalifa University, PO Box 127788, Abu Dhabi, United Arab Emirates
| | - Faezeh Marzbanrad
- Department of Electrical and Electronic Engineering, Monash University, 14 Alliance Lane (Building 72), Clayton Victoria, 3800, Australia
| | - Yoshitaka Kimura
- Graduate School of Medicine, Tohoku University, Sendai, Miyagi, 980-8575, Japan
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Chen YJ, Hwang SL, Li CR, Yang CC, Huang KL, Lin CY, Lee CY. Vagal withdrawal and psychological distress during ventilator weaning and the related outcomes. J Psychosom Res 2017; 101:10-16. [PMID: 28867413 DOI: 10.1016/j.jpsychores.2017.07.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 07/25/2017] [Accepted: 07/26/2017] [Indexed: 02/01/2023]
Abstract
OBJECTIVE This study investigated the associations between changes in autonomic nervous system (ANS) function, psychological status during the mechanical ventilation (MV) weaning process, and weaning outcomes. METHODS In this prospective study, we recruited 67 patients receiving MV for >24h at a medical center in northern Taiwan. Patients' ANS function, represented by heart rate variability (HRV), the rapid shallow breathing index (RSBI), anxiety, fear, and dyspnea, was repeatedly measured 10min before and 30min after undergoing a weaning trial. Forty-nine patients capable of sustaining a 2-h weaning trial were successfully weaned. RESULTS Compared with the failed group, the success group showed significantly smaller decreases in high-frequency HRV (HRV-HF) and smaller increases in RSBI (per 10 breaths/min/L), fear, dyspnea, and anxiety in response to the weaning trial (odds ratio [OR]=2.19, 0.81, 0.69, 0.66, and 0.77, respectively; p<0.05). Multivariate analyses revealed that low-frequency HRV before weaning (OR=2.32; 95% confidence interval [CI]=1.13-4.78, p=0.02), changes in HRV-HF (OR=3.33; 95% CI=1.18-9.44, p=0.02), and psychological fear during the weaning process (OR=0.50; 95% CI=0.27-0.92, p=0.03) were three independent factors associated with 2-h T-piece weaning success. CONCLUSIONS ANS responses and psychological distress during weaning were associated with T-piece weaning outcomes and may reflect the need for future studies to utilize these factors to guide weaning processes and examine their impact on outcomes.
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Affiliation(s)
- Yu-Ju Chen
- School of Nursing, National Defense Medical Center, Taipei, Taiwan.
| | - Shiow-Li Hwang
- Department of Nursing, Asia University, Taichung, Taiwan
| | - Chi-Rong Li
- Department of Teaching and Research, Taichung Hospital, Ministry of Health and Welfare, Taiwan
| | - Chia-Chen Yang
- School of Nursing, National Defense Medical Center, Taipei, Taiwan
| | - Kun-Lun Huang
- Hyperbaric Oxygen Therapy Center, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Yuan Lin
- Department of Surgery, National Defense Medical Center, Division of Cardiovascular Surgery, Tri-Service General Hospital, Taipei, Taiwan
| | - Ching-Yi Lee
- Division of Pulmonary and Critical Care Medicine, Tri-Service General Hospital, Taipei, Taiwan
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Marzbanrad F, Khandoker AH, Kimura Y, Palaniswami M, Clifford GD. Assessment of Fetal Development Using Cardiac Valve Intervals. Front Physiol 2017; 8:313. [PMID: 28567021 PMCID: PMC5434138 DOI: 10.3389/fphys.2017.00313] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 05/01/2017] [Indexed: 11/28/2022] Open
Abstract
An automated method to assess the fetal physiological development is introduced which uses the component intervals between fetal cardiac valve timings and the Q-wave of fetal electrocardiogram (fECG). These intervals were estimated automatically from one-dimensional Doppler Ultrasound and noninvasive fECG. We hypothesize that the fetal growth can be estimated by the cardiac valve intervals. This hypothesis was evaluated by modeling the fetal development using the cardiac intervals and validating against the gold standard gestational age identified by Crown-Rump Length (CRL). Among the intervals, electromechanical delay time, isovolumic contraction time, ventricular filling time and their interactions were selected in a stepwise regression process that used gestational age as the target in a cohort of 57 fetuses. Compared with the gold standard age, the newly proposed regression model resulted in a mean absolute error of 3.8 weeks for all recordings and 2.7 weeks after excluding the low quality recordings. Since Fetal Heart Rate Variability (FHRV) has been proposed in the literature for assessing the fetal development, we compared the performance of gestational age estimation by our new valve-interval based method, vs. FHRV, while assuming the CRL as the gold standard. The valve interval-based method outperformed both the model based on FHRV. Results of evaluation for 30 abnormal cases showed that the new method is less affected by arrhythmias such as tachycardia and bradycardia compared to FHRV, however certain types of heart anomalies cause large errors (more than 10 weeks) with respect to the CRL-based gold standard age. Therefore, discrepancies between the regression based estimation and CRL age estimation could indicate the abnormalities. The cardiac valve intervals have been known to reflect the autonomic function. Therefore the new method potentially provides a novel approach for assessing the development of fetal autonomic nervous system, which may be growth curve independent.
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Affiliation(s)
- Faezeh Marzbanrad
- Department of Electrical and Computer Systems Engineering, Monash UniversityClayton, VIC, Australia
| | - Ahsan H Khandoker
- Electrical and Electronic Engineering Department, University of MelbourneMelbourne, VIC, Australia.,Biomedical Engineering Department, Khalifa University of Science, Technology and ResearchAbu Dhabi, United Arab Emirates
| | | | - Marimuthu Palaniswami
- Electrical and Electronic Engineering Department, University of MelbourneMelbourne, VIC, Australia
| | - Gari D Clifford
- Department of Biomedical Informatics, Emory UniversityAtlanta, GA, United States.,Department of Biomedical Engineering, Georgia Institute of TechnologyAtlanta, GA, United States
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Management of Mechanical Ventilation in Decompensated Heart Failure. J Cardiovasc Dev Dis 2016; 3:jcdd3040033. [PMID: 29367576 PMCID: PMC5715720 DOI: 10.3390/jcdd3040033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 11/22/2016] [Accepted: 11/29/2016] [Indexed: 02/04/2023] Open
Abstract
Mechanical ventilation (MV) is a life-saving intervention for respiratory failure, including decompensated congestive heart failure. MV can reduce ventricular preload and afterload, decrease extra-vascular lung water, and decrease the work of breathing in heart failure. The advantages of positive pressure ventilation must be balanced with potential harm from MV: volutrauma, hyperoxia-induced injury, and difficulty assessing readiness for liberation. In this review, we will focus on cardiac, pulmonary, and broader effects of MV on patients with decompensated HF, focusing on practical considerations for management and supporting evidence.
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Toklu HZ, Kwon OS, Sakarya Y, Powers SK, Llinas K, Kirichenko N, Sollanek KJ, Wiggs MP, Smuder AJ, Talbert EE, Scarpace PJ, Tümer N. The effects of enalapril and losartan on mechanical ventilation–induced sympathoadrenal activation and oxidative stress in rats. J Surg Res 2014; 188:510-6. [DOI: 10.1016/j.jss.2014.01.054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 01/07/2014] [Accepted: 01/30/2014] [Indexed: 10/25/2022]
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Reis MS, Sampaio LM, Lacerda D, De Oliveira LV, Pereira GB, Pantoni CB, Thommazo LD, Catai AM, Borghi-Silva A. Acute effects of different levels of continuous positive airway pressure on cardiac autonomic modulation in chronic heart failure and chronic obstructive pulmonary disease. Arch Med Sci 2010; 6:719-27. [PMID: 22419931 PMCID: PMC3298341 DOI: 10.5114/aoms.2010.17087] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 04/07/2010] [Accepted: 04/21/2010] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Non-invasive ventilation may improve autonomic modulation and ventilatory parameters in severely disabled patients. The aim of the present study was to evaluate the physiological influence of acute treatment with different levels of continuous positive airway pressure (CPAP) on the autonomic balance of heart and respiratory responses in patients with stable chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). MATERIALS AND METHODS A COPD group (n = 10), CHF group (n = 8) and healthy subjects (n = 10) were evaluated. The participants were randomized to receive three different levels of CPAP on the same day: sham ventilation (Sham), 5 cmH(2)0 (CPAP5) and 10 cmH(2)0 (CPAP10) for 10 min. Respiratory rate, end tidal carbon dioxide (E(T)CO(2)), peripheral oxygen saturation (SpO(2)), heart rate (HR), blood pressure and heart rate variability in the time and frequency domains were measured during spontaneous breathing and under the sham, CPAP5 and CPAP10 conditions. RESULTS All groups experienced a reduction in E(T)CO(2) values during treatment with CPAP (p < 0.05). CPAP increased SpO(2) and HR in the COPD group (p < 0.05). The COPD group also had lower RMSSD values during treatment with different levels of CPAP when compared to the control group (p < 0.05). In the CHF group, CPAP5 and CPAP10 increased the SDNN value (p < 0.05). CPAP10 reduced the SDNN value in the COPD group (p < 0.05). CONCLUSION The findings suggest that CPAP may cause improvements in the neural control of heart rate in patients with stable COPD and CHF. For each patient, the "best CPAP level" should be defined as the best respiratory response and autonomic balance.
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Affiliation(s)
- Michel S. Reis
- Cardiopulmonary Physiotherapy Laboratory, Center for Research in Physical Exercise, Federal University of São Carlos, São Paulo, Brazil
| | - Luciana M.M. Sampaio
- Rehabilitation Sciences Master's Program, Nove de Julho University, São Paulo, Brazil
| | - Diego Lacerda
- Rehabilitation Sciences Master's Program, Nove de Julho University, São Paulo, Brazil
| | - Luis V.F. De Oliveira
- Rehabilitation Sciences Master's Program, Nove de Julho University, São Paulo, Brazil
| | - Guilherme B. Pereira
- Cardiopulmonary Physiotherapy Laboratory, Center for Research in Physical Exercise, Federal University of São Carlos, São Paulo, Brazil
| | - Camila B.F. Pantoni
- Cardiopulmonary Physiotherapy Laboratory, Center for Research in Physical Exercise, Federal University of São Carlos, São Paulo, Brazil
| | - Luciana Di Thommazo
- Cardiopulmonary Physiotherapy Laboratory, Center for Research in Physical Exercise, Federal University of São Carlos, São Paulo, Brazil
| | - Aparecida M. Catai
- Cardiopulmonary Physiotherapy Laboratory, Center for Research in Physical Exercise, Federal University of São Carlos, São Paulo, Brazil
| | - Audrey Borghi-Silva
- Cardiopulmonary Physiotherapy Laboratory, Center for Research in Physical Exercise, Federal University of São Carlos, São Paulo, Brazil
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Pilot safety study of low-dose vasopressin in non-septic critically ill children. Intensive Care Med 2009; 35:355-9. [PMID: 19132338 DOI: 10.1007/s00134-008-1392-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2008] [Accepted: 11/17/2008] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess the safety of low-dose vasopressin infusion in critically ill children requiring prolonged mechanical ventilation (MV) at risk of developing sedation/analgesia-related hypotension. METHOD Randomized pilot safety study in children expected to require MV for at least 3 days. Children received either vasopressin (0.0005 U/kg/min) or sodium chloride (0.9%) infusion for a period of 48 h. Haemodynamic variables, urine output and serum electrolytes were closely monitored and analyzed. RESULTS Twelve children in each group had similar baseline characteristics. Vasopressin infusion was associated with an 8 mmol/L fall in serum sodium concentration (p < 0.01) and with higher incidence of hyponatraemia (8 vs. 66%, p < 0.01). In normotensive children, low-dose vasopressin also induced a reversible decrease in urine output, and acutely increased blood pressure (p < 0.01). After stopping the vasopressin there was rebound hypotension (p < 0.01). CONCLUSION Low-dose vasopressin infusion in haemodynamically stable, but critically ill, children is associated with reduction in urine output and decreased serum sodium level, yielding a high incidence of hyponatraemia. We conclude that these effects limit further study of prophylactic vasopressin for sedation-related hypotension in a randomized controlled trial.
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