Decreased respiratory rate variability during mechanical ventilation is associated with increased mortality

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• 作者：Guillermo Gutierrez (1)
  Aparna Das (1)
  Guillermo Ballarino (1)
  Arshan Beyzaei-Arani (1)
  Hülya Türkan (2)
  Marian Wulf-Gutierrez (3)
  Katherine Rider (1)
  Hatice Kaya (1) (4)
  Richard Amdur (5) (6)
  
• 关键词：Continuous monitoring ; Patient ; ventilator asynchrony ; Sedation ; Neuromuscular blockers
• 刊名：Intensive Care Medicine
• 出版年：2013
• 出版时间：August 2013
• 年：2013
• 卷：39
• 期：8
• 页码：1359-1367
• 全文大小：300KB
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• 作者单位：Guillermo Gutierrez (1)
  Aparna Das (1)
  Guillermo Ballarino (1)
  Arshan Beyzaei-Arani (1)
  Hülya Türkan (2)
  Marian Wulf-Gutierrez (3)
  Katherine Rider (1)
  Hatice Kaya (1) (4)
  Richard Amdur (5) (6)
  
  1. Pulmonary, Critical Care and Sleep Medicine Division, The George Washington University MFA, 2150 Pennsylvania Ave, NW, Washington DC, 20037, USA
  2. Department of Anesthesiology, TUBITAK Research Scholar, Gülhane Military Medical Faculty, Ankara, Turkey
  3. Department of Obstetrics and Gynecology, Georgetown University, Washington DC, USA
  4. Pulmonary Division, Gülhane Military Medical Faculty, Ankara, Turkey
  5. Department of Surgery, The George Washington University MFA, Washington DC, USA
  6. VA Medical Center, Washington DC, USA
  

文摘

Objective Patients on ventilatory support often experience significant changes in respiratory rate. Our aim was to determine the possible association between respiratory rate variability (RRV) and outcomes in these patients. Design A longitudinal, prospective, observational study of patients mechanically ventilated for at least 12?h performed in a medical-surgical intensive care unit. Patients were enrolled within 24?h of the initiation of ventilatory support. We measured airway signals continuously for the duration of ventilatory support and calculated expiratory flow frequency spectra at 2.5-min intervals. We assessed RRV using the amplitude ratio of the flow spectrum’s first harmonic to the zero frequency component. Measures of the amplitude ratio were averaged over the total monitored time. Patients with time-averaged amplitude ratios <40?% were classified as high RRV and those ?0?% as low RRV. All-cause mortality rates were assessed at 28 and 180?days from enrollment with a Cox proportional hazards model adjusted for disease acuity by the simplified acute physiology score II. Results We enrolled 178 patients, of whom 47 had high RRV and 131 low RRV. Both groups had similar disease acuity upon enrollment. The 28- and 180-day mortality rates were greater for low RRV patients with hazard ratios of 4.81 (95?% CI 1.85-2.65, p?=?0.001) and 2.26 (95?% CI 1.21-.20, p?=?0.01), respectively. Independent predictors of 28-day mortality were low RRV, i.v. vasopressin, and SAPS II. Conclusions Decreased RRV during ventilatory support is associated with increased mortality. The mechanisms responsible for this finding remain to be determined.