The Control of Breathing during Weaning from Mechanical Ventilation
Using the recruitment threshold technique, we measured the CO2 responsiveness of the unloaded respiratory pump in 14 mechanically ventilated patients prior to weaning. The CO2 recruitment threshold (CO2RT) was compared with the arterial CO2 tension during unassisted breathing (CO2SB) and with the Pa...
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| Veröffentlicht in: | Chest 1991-09, Vol.100 (3), p.754-761 |
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| creator | Dunn, William F. Nelson, Steven B. Hubmayr, Rolf D. |
| description | Using the recruitment threshold technique, we measured the CO2 responsiveness of the unloaded respiratory pump in 14 mechanically ventilated patients prior to weaning. The CO2 recruitment threshold (CO2RT) was compared with the arterial CO2 tension during unassisted breathing (CO2SB) and with the PaCO2 during mechanical ventilation (CO2MV) at machine settings determined by the primary physician. Based on these comparisons, we tested the hypotheses that (1) patients without weaning-induced respiratory distress (group 1) maintain CO2SB near CO2RT, (2) patients with weaning-induced respiratory distress (group 2) retain CO2SB above CO2RT, thereby manifesting incomplete load compensation, and (3) CO2MV is ventilator setting dependent and provides insufficient information about the ventilatory requirement during weaning. Respiratory distress was prospectively defined as sustained tachypnea (rate≥30) or intense dyspnea (Borg scale rating) and limited weaning in nine of 14 patients. The average CO2RT was 40 mm Hg in both groups. All patients in group 1 maintained CO2SB near CO2RT (p=0.1). Seven of nine patients in group 2 retained CO2 by ≥3 mm Hg above CO2RT (p |
| doi_str_mv | 10.1378/chest.100.3.754 |
| format | Article |
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The CO2 recruitment threshold (CO2RT) was compared with the arterial CO2 tension during unassisted breathing (CO2SB) and with the PaCO2 during mechanical ventilation (CO2MV) at machine settings determined by the primary physician. Based on these comparisons, we tested the hypotheses that (1) patients without weaning-induced respiratory distress (group 1) maintain CO2SB near CO2RT, (2) patients with weaning-induced respiratory distress (group 2) retain CO2SB above CO2RT, thereby manifesting incomplete load compensation, and (3) CO2MV is ventilator setting dependent and provides insufficient information about the ventilatory requirement during weaning. Respiratory distress was prospectively defined as sustained tachypnea (rate≥30) or intense dyspnea (Borg scale rating) and limited weaning in nine of 14 patients. The average CO2RT was 40 mm Hg in both groups. All patients in group 1 maintained CO2SB near CO2RT (p=0.1). Seven of nine patients in group 2 retained CO2 by ≥3 mm Hg above CO2RT (p<0.01). There was no significant difference between CO2MV and CO2SB in either group. We conclude that CO2RT provides a better reference of the adequacy of ventilatory load compensation during weather than CO2MV. ( Chest 1991; 100:754-61)</description><identifier>ISSN: 0012-3692</identifier><identifier>EISSN: 1931-3543</identifier><identifier>DOI: 10.1378/chest.100.3.754</identifier><identifier>PMID: 1909619</identifier><identifier>CODEN: CHETBF</identifier><language>eng</language><publisher>Northbrook, IL: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Carbon Dioxide - blood ; Carbon Dioxide - physiology ; Female ; Humans ; Intensive care medicine ; Male ; Medical sciences ; Middle Aged ; Recruitment, Neurophysiological ; Respiration - physiology ; Space life sciences ; Ventilator Weaning</subject><ispartof>Chest, 1991-09, Vol.100 (3), p.754-761</ispartof><rights>1991 The American College of Chest Physicians</rights><rights>1992 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c411t-d052f9add1e5ef85c30d19ae247348dde2cbb85e3f3cb85a2e83d9780e1964143</citedby><cites>FETCH-LOGICAL-c411t-d052f9add1e5ef85c30d19ae247348dde2cbb85e3f3cb85a2e83d9780e1964143</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>309,310,314,776,780,785,786,23909,23910,25118,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=5417262$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/1909619$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dunn, William F.</creatorcontrib><creatorcontrib>Nelson, Steven B.</creatorcontrib><creatorcontrib>Hubmayr, Rolf D.</creatorcontrib><title>The Control of Breathing during Weaning from Mechanical Ventilation</title><title>Chest</title><addtitle>Chest</addtitle><description>Using the recruitment threshold technique, we measured the CO2 responsiveness of the unloaded respiratory pump in 14 mechanically ventilated patients prior to weaning. The CO2 recruitment threshold (CO2RT) was compared with the arterial CO2 tension during unassisted breathing (CO2SB) and with the PaCO2 during mechanical ventilation (CO2MV) at machine settings determined by the primary physician. Based on these comparisons, we tested the hypotheses that (1) patients without weaning-induced respiratory distress (group 1) maintain CO2SB near CO2RT, (2) patients with weaning-induced respiratory distress (group 2) retain CO2SB above CO2RT, thereby manifesting incomplete load compensation, and (3) CO2MV is ventilator setting dependent and provides insufficient information about the ventilatory requirement during weaning. Respiratory distress was prospectively defined as sustained tachypnea (rate≥30) or intense dyspnea (Borg scale rating) and limited weaning in nine of 14 patients. The average CO2RT was 40 mm Hg in both groups. All patients in group 1 maintained CO2SB near CO2RT (p=0.1). Seven of nine patients in group 2 retained CO2 by ≥3 mm Hg above CO2RT (p<0.01). There was no significant difference between CO2MV and CO2SB in either group. We conclude that CO2RT provides a better reference of the adequacy of ventilatory load compensation during weather than CO2MV. ( Chest 1991; 100:754-61)</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Carbon Dioxide - blood</subject><subject>Carbon Dioxide - physiology</subject><subject>Female</subject><subject>Humans</subject><subject>Intensive care medicine</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Recruitment, Neurophysiological</subject><subject>Respiration - physiology</subject><subject>Space life sciences</subject><subject>Ventilator Weaning</subject><issn>0012-3692</issn><issn>1931-3543</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1991</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1UE1P3DAUtFArWChnTkg5VL1l8bPz5WO7akslKi5Aj5bXfiFGjg120op_Xy9ZFS49jUZvZt57Q8gZ0DXwtrvQA6ZpDZSu-bqtqwOyAsGh5HXF35EVpcBK3gh2RI5TeqCZg2gOySEIKhoQK7K5GbDYBD_F4IrQF18iqmmw_r4wc9zBL1R-h30MY_ET9ZCpVq64Qz9ZpyYb_Afyvlcu4ekeT8jtt683m8vy6vr7j83nq1JXAFNpaM16oYwBrLHvas2pAaGQVS2vOmOQ6e22q5H3XGdUDDtuRNtRzDdXUPET8mnJfYzhac5_y9Emjc4pj2FOsmVUsA6aLLxYhDqGlCL28jHaUcVnCVTuapMvtWVGJZe5tuw430fP2xHNq37pKc8_7ucq5e_7qLy26Z-srqBlDXtdPNj74Y-NKNOonMuhfFn5EObolXu7WCwOzMX9thhl0ha9RpPdepIm2P8e_Rfl5ZqO</recordid><startdate>19910901</startdate><enddate>19910901</enddate><creator>Dunn, William F.</creator><creator>Nelson, Steven B.</creator><creator>Hubmayr, Rolf D.</creator><general>Elsevier Inc</general><general>American College of Chest Physicians</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19910901</creationdate><title>The Control of Breathing during Weaning from Mechanical Ventilation</title><author>Dunn, William F. ; Nelson, Steven B. ; Hubmayr, Rolf D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c411t-d052f9add1e5ef85c30d19ae247348dde2cbb85e3f3cb85a2e83d9780e1964143</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1991</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Carbon Dioxide - blood</topic><topic>Carbon Dioxide - physiology</topic><topic>Female</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Recruitment, Neurophysiological</topic><topic>Respiration - physiology</topic><topic>Space life sciences</topic><topic>Ventilator Weaning</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dunn, William F.</creatorcontrib><creatorcontrib>Nelson, Steven B.</creatorcontrib><creatorcontrib>Hubmayr, Rolf D.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Chest</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dunn, William F.</au><au>Nelson, Steven B.</au><au>Hubmayr, Rolf D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Control of Breathing during Weaning from Mechanical Ventilation</atitle><jtitle>Chest</jtitle><addtitle>Chest</addtitle><date>1991-09-01</date><risdate>1991</risdate><volume>100</volume><issue>3</issue><spage>754</spage><epage>761</epage><pages>754-761</pages><issn>0012-3692</issn><eissn>1931-3543</eissn><coden>CHETBF</coden><abstract>Using the recruitment threshold technique, we measured the CO2 responsiveness of the unloaded respiratory pump in 14 mechanically ventilated patients prior to weaning. The CO2 recruitment threshold (CO2RT) was compared with the arterial CO2 tension during unassisted breathing (CO2SB) and with the PaCO2 during mechanical ventilation (CO2MV) at machine settings determined by the primary physician. Based on these comparisons, we tested the hypotheses that (1) patients without weaning-induced respiratory distress (group 1) maintain CO2SB near CO2RT, (2) patients with weaning-induced respiratory distress (group 2) retain CO2SB above CO2RT, thereby manifesting incomplete load compensation, and (3) CO2MV is ventilator setting dependent and provides insufficient information about the ventilatory requirement during weaning. Respiratory distress was prospectively defined as sustained tachypnea (rate≥30) or intense dyspnea (Borg scale rating) and limited weaning in nine of 14 patients. The average CO2RT was 40 mm Hg in both groups. All patients in group 1 maintained CO2SB near CO2RT (p=0.1). Seven of nine patients in group 2 retained CO2 by ≥3 mm Hg above CO2RT (p<0.01). There was no significant difference between CO2MV and CO2SB in either group. We conclude that CO2RT provides a better reference of the adequacy of ventilatory load compensation during weather than CO2MV. ( Chest 1991; 100:754-61)</abstract><cop>Northbrook, IL</cop><pub>Elsevier Inc</pub><pmid>1909619</pmid><doi>10.1378/chest.100.3.754</doi><tpages>8</tpages></addata></record> |
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| ispartof | Chest, 1991-09, Vol.100 (3), p.754-761 |
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| subjects | Aged Aged, 80 and over Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Carbon Dioxide - blood Carbon Dioxide - physiology Female Humans Intensive care medicine Male Medical sciences Middle Aged Recruitment, Neurophysiological Respiration - physiology Space life sciences Ventilator Weaning |
| title | The Control of Breathing during Weaning from Mechanical Ventilation |
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