A Pilot Study of Short-Term High-Pressure Support Ventilation in Persistent Sudden-Onset Rapid Breathing

Abstract

Sudden-onset rapid breathing commonly occurs in previously calm, invasively-ventilated patients. In most cases it can be resolved easily by traditional management techniques, but other cases can be very challenging. We enrolled 40 patients who failed traditional interventions and performed short-term high-pressure support ventilation (HPSV). Thirty-three (83%) patients were responsive to HPSV. In the responders, ten minute HPSV reduced mean airway pressure (P=0.030), minute ventilation (P <0.001), respiratory rate (P <0.001) and heart rate (P <0.001) compared to before HPSV therapy. It also stabilised tidal volume (P <0.001) and improved oxygenation (P=0.007). After 58 minutes, HPSV relieved tachypnoea. However, compared with the responders, the non-responders (7/40, 17%) were younger (77.0 versus 59.7 years, P=0.002), and had higher Glasgow Coma Scale score (9.0 versus 14.0, P <0.001), pressure support (P=0.029), peak pressure (P=0.048) and heart rate (P=0.004) before sudden-onset rapid breathing. The non-responders also had higher peak pressure (P=0.046), minute ventilation (P=0.024), respiratory rate (P=0.027) and heart rate (P <0.001) when the rapid breathing happened. At or before sudden-onset rapid breathing, peak pressure, minute ventilation and heart rate had a high accuracy to predict the non-responsive patients (each with area under the curve of ≥0.7). The age and Glasgow Coma Scale also had high predicted ability (both with areas under the curve of ≥0.8). In conclusion, short-term HPSV relieved persistent sudden-onset rapid breathing. However, it was not effective in the relatively young and conscious patients with relatively high support pressure, peak pressure, minute ventilation and heart rate.