Abstract
IntroductionThe process of weaning may impose cardiopulmonary stress on ventilated patients. Heart-rate variability (HRV), a noninvasive tool to characterize autonomic function and cardiorespiratory interaction, may be a promising modality to assess patient capability during the weaning process. We aimed to evaluate the association between HRV change and weaning outcomes in critically ill patients.MethodsThis study included 101 consecutive patients recovering from acute respiratory failure. Frequency-domain analysis, including very low frequency, low frequency, high frequency, and total power of HRV was assessed during a 1-hour spontaneous breathing trial (SBT) through a T-piece and after extubation after successful SBT.ResultsOf 101 patients, 24 (24%) had SBT failure, and HRV analysis in these patients showed a significant decrease in total power (P = 0.003); 77 patients passed SBT and were extubated, but 13 (17%) of them required reintubation within 72 hours. In successfully extubated patients, very low frequency and total power from SBT to postextubation significantly increased (P = 0.003 and P = 0.004, respectively). Instead, patients with extubation failure were unable to increase HRV after extubation.ConclusionsHRV responses differ between patients with different weaning outcomes. Measuring HRV change during the weaning process may help clinicians to predict weaning results and, in the end, to improve patient care and outcome.
Highlights
The process of weaning may impose cardiopulmonary stress on ventilated patients
Other than total power (TP), which is a reflection of total Heart-rate variability (HRV), we found that change of very low frequency (VLF) was useful in risk stratification for predicting extubation outcome
Our results provide the first evidence that HRV increased after extubation in patients who succeeded in 1-hour spontaneous breathing trial (SBT) and were successfully extubated
Summary
The process of weaning may impose cardiopulmonary stress on ventilated patients. Heart-rate variability (HRV), a noninvasive tool to characterize autonomic function and cardiorespiratory interaction, may be a promising modality to assess patient capability during the weaning process. We aimed to evaluate the association between HRV change and weaning outcomes in critically ill patients. Weaning patients with respiratory failure from ventilatory support is one of the most challenging problems in intensive care. Spontaneous breathing trial (SBT) is considered the most accurate index for predicting weaning success, 15% to 20% of patients succeeding in SBT require reintubation [3,4]. The pathophysiology of weaning failure is complex and involves interaction between cardiopulmonary reserve, autonomic function, and musculoskeletal capacity [5,6].
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