H Rozé1, A Germain2, V Perrier2, A Dewitte3, O Joannes-Boyau2, C Fleureau2, A Ouattara4. 1. CHU de Bordeaux, Service d'Anesthésie-Réanimation II, Unité de Réanimation polyvalente de la Maison du Haut-Lévêque, Hôpital Haut Lévêque, Avenue Magellan, F-33600 Pessac, France University of Bordeaux, Adaptation cardiovasculaire à l'ischémie, U1034, F-33600 Pessac, France INSERM, Adaptation cardiovasculaire à l'ischémie, U1034, F-33600 Pessac, France hadrien.roze@chu-bordeaux.fr. 2. CHU de Bordeaux, Service d'Anesthésie-Réanimation II, Unité de Réanimation polyvalente de la Maison du Haut-Lévêque, Hôpital Haut Lévêque, Avenue Magellan, F-33600 Pessac, France. 3. CHU de Bordeaux, Service d'Anesthésie-Réanimation II, Unité de Réanimation polyvalente de la Maison du Haut-Lévêque, Hôpital Haut Lévêque, Avenue Magellan, F-33600 Pessac, France University of Bordeaux, Bioingénierie tissulaire, U1026, F-33000 Bordeaux, France. 4. CHU de Bordeaux, Service d'Anesthésie-Réanimation II, Unité de Réanimation polyvalente de la Maison du Haut-Lévêque, Hôpital Haut Lévêque, Avenue Magellan, F-33600 Pessac, France University of Bordeaux, Adaptation cardiovasculaire à l'ischémie, U1034, F-33600 Pessac, France INSERM, Adaptation cardiovasculaire à l'ischémie, U1034, F-33600 Pessac, France.
Abstract
BACKGROUND: Diaphragm electrical activation (EAdi) and the ratio of tidal volume to EAdi (VT/EAdi) may provide clinical information on neuroventilatory efficiency (NVE) in patients being weaned from mechanical ventilation. We tested the hypothesis that residual sedation could interfere with respiratory recovery, by assessing the effects of flumazenil on EAdi and VT/EAdi ratio. METHODS: This observational study included 13 patients breathing with pressure-support ventilation (PSV) after a long period of controlled mechanical ventilation (i.e. >4 days) plus midazolam-based sedation for acute respiratory distress syndrome. EAdi and respiratory patterns were compared before and after a bolus of flumazenil, which was given because neurological status needed to be evaluated. RESULTS: Flumazenil induced a significant increase in EAdi [+71 (41-123)%, P=0.0002] and VT [+17 (8-32)%, P=0.0005], resulting in significantly decreased NVE [-34 (15-43)%]. The increased VT was significantly correlated with the increased EAdi (ρ=0.70, P=0.009). CONCLUSIONS: During weaning from mechanical ventilation, the diaphragmatic contribution to the breathing process may be reduced by residual midazolam-induced ventilatory depression. The increased EAdi with reversal of residual sedation was associated with a proportional increase in VT. These findings should be considered by the attending physician when interpreting daily EAdi and VT changes during weaning from mechanical ventilation.
BACKGROUND: Diaphragm electrical activation (EAdi) and the ratio of tidal volume to EAdi (VT/EAdi) may provide clinical information on neuroventilatory efficiency (NVE) in patients being weaned from mechanical ventilation. We tested the hypothesis that residual sedation could interfere with respiratory recovery, by assessing the effects of flumazenil on EAdi and VT/EAdi ratio. METHODS: This observational study included 13 patients breathing with pressure-support ventilation (PSV) after a long period of controlled mechanical ventilation (i.e. >4 days) plus midazolam-based sedation for acute respiratory distress syndrome. EAdi and respiratory patterns were compared before and after a bolus of flumazenil, which was given because neurological status needed to be evaluated. RESULTS:Flumazenil induced a significant increase in EAdi [+71 (41-123)%, P=0.0002] and VT [+17 (8-32)%, P=0.0005], resulting in significantly decreased NVE [-34 (15-43)%]. The increased VT was significantly correlated with the increased EAdi (ρ=0.70, P=0.009). CONCLUSIONS: During weaning from mechanical ventilation, the diaphragmatic contribution to the breathing process may be reduced by residual midazolam-induced ventilatory depression. The increased EAdi with reversal of residual sedation was associated with a proportional increase in VT. These findings should be considered by the attending physician when interpreting daily EAdi and VT changes during weaning from mechanical ventilation.
Authors: Elena Spinelli; Tommaso Mauri; Jeremy R Beitler; Antonio Pesenti; Daniel Brodie Journal: Intensive Care Med Date: 2020-02-03 Impact factor: 17.440