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Clinical risk factors for increased respiratory drive in intubated hypoxemic patients.
Spinelli, Elena; Pesenti, Antonio; Slobod, Douglas; Fornari, Carla; Fumagalli, Roberto; Grasselli, Giacomo; Volta, Carlo Alberto; Foti, Giuseppe; Navalesi, Paolo; Knafelj, Rihard; Pelosi, Paolo; Mancebo, Jordi; Brochard, Laurent; Mauri, Tommaso.
Afiliação
  • Spinelli E; Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Pesenti A; Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Slobod D; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
  • Fornari C; Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Fumagalli R; Department of Critical Care Medicine, McGill University, Montreal, QC, Canada.
  • Grasselli G; Research Centre On Public Health, University of Milano - Bicocca, Monza, Italy.
  • Volta CA; Anesthesia and Critical Care Service 1, Niguarda Hospital, Milan, Italy.
  • Foti G; Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Navalesi P; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
  • Knafelj R; Morphology, Surgery and Experimental Medicine, Anesthesia and Intensive Care Unit, University of Ferrara, Ferrara, Italy.
  • Pelosi P; Anesthesia and Critical Care, San Gerardo Hospital, ASST Monza, Monza, Italy.
  • Mancebo J; Anesthesia and Intensive Care, Department of Medicine - DIMED, Padua University Hospital, University of Padua, Padua, Italy.
  • Brochard L; Center for Internal Intensive Medicine (MICU), University Medical Center Ljubljana, Ljubljana, Slovenia.
  • Mauri T; Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy.
Crit Care ; 27(1): 138, 2023 04 11.
Article em En | MEDLINE | ID: mdl-37041553
BACKGROUND: There is very limited evidence identifying factors that increase respiratory drive in hypoxemic intubated patients. Most physiological determinants of respiratory drive cannot be directly assessed at the bedside (e.g., neural inputs from chemo- or mechano-receptors), but clinical risk factors commonly measured in intubated patients could be correlated with increased drive. We aimed to identify clinical risk factors independently associated with increased respiratory drive in intubated hypoxemic patients. METHODS: We analyzed the physiological dataset from a multicenter trial on intubated hypoxemic patients on pressure support (PS). Patients with simultaneous assessment of the inspiratory drop in airway pressure at 0.1-s during an occlusion (P0.1) and risk factors for increased respiratory drive on day 1 were included. We evaluated the independent correlation of the following clinical risk factors for increased drive with P0.1: severity of lung injury (unilateral vs. bilateral pulmonary infiltrates, PaO2/FiO2, ventilatory ratio); arterial blood gases (PaO2, PaCO2 and pHa); sedation (RASS score and drug type); SOFA score; arterial lactate; ventilation settings (PEEP, level of PS, addition of sigh breaths). RESULTS: Two-hundred seventeen patients were included. Clinical risk factors independently correlated with higher P0.1 were bilateral infiltrates (increase ratio [IR] 1.233, 95%CI 1.047-1.451, p = 0.012); lower PaO2/FiO2 (IR 0.998, 95%CI 0.997-0.999, p = 0.004); higher ventilatory ratio (IR 1.538, 95%CI 1.267-1.867, p < 0.001); lower pHa (IR 0.104, 95%CI 0.024-0.464, p = 0.003). Higher PEEP was correlated with lower P0.1 (IR 0.951, 95%CI 0.921-0.982, p = 0.002), while sedation depth and drugs were not associated with P0.1. CONCLUSIONS: Independent clinical risk factors for higher respiratory drive in intubated hypoxemic patients include the extent of lung edema and of ventilation-perfusion mismatch, lower pHa, and lower PEEP, while sedation strategy does not affect drive. These data underline the multifactorial nature of increased respiratory drive.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Respiração Artificial / Respiração com Pressão Positiva Tipo de estudo: Clinical_trials / Etiology_studies / Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Respiração Artificial / Respiração com Pressão Positiva Tipo de estudo: Clinical_trials / Etiology_studies / Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article