Hypercapnic Ventilatory Response in the Weaning of Patients with Prolonged Mechanical Ventilation

Objective To investigate whether hypercapnic ventilatory response (defined as the ratio of the change in minute ventilation [ΔV˙E] to the change in end-tidal partial pressure of carbon dioxide [ΔPETCO2]) is a predictor of successful weaning in patients with prolonged mechanical ventilation (PMV) and to determine a reference value for clinical use. Methods A hypercapnic challenge test was performed on 32 PMV subjects (average age: 74.3 years ± 14.9 years). The subjects were divided into two groups (i.e., weaning successes and weaning failures) and their hypercapnic ventilatory responses were compared. Results PMV subjects had an overall weaning rate of 68.8%. The weaning-success and weaning-failure groups had hypercapnic ventilatory responses (ΔV˙E/ΔPETCO2) of 0.40 ± 0.16 and 0.28 ± 0.12 L/min/mmHg, respectively (P = .036). The area under the receiver operating characteristic curve was 0.716 of the hypercapnic ventilatory response, and the practical hypercapnic ventilatory response cut-off point for successful weaning was 0.265 with 86.4% sensitivity and 50% specificity. Conclusions PMV subjects who failed weaning had a lower hypercapnic ventilatory response than successfully weaned subjects. However, the prediction capacity of this test, assessed by the area under the receiver operating characteristic (ROC) curve, poorly predicted weaning outcome.

[1]  C. Thomson,et al.  Management of Adults with Hospital-acquired and Ventilator-associated Pneumonia. , 2016, Annals of the American Thoracic Society.

[2]  Chen Wang,et al.  Survey of Prolonged Mechanical Ventilation in Intensive Care Units in Mainland China , 2016, Respiratory Care.

[3]  P. Fey,et al.  Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. , 2016, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[4]  D. Silage,et al.  Effects of aging on ventilatory and occlusion pressure responses to hypoxia and hypercapnia. , 2015, The American review of respiratory disease.

[5]  R. Kaner,et al.  Prolonged Mechanical Ventilation in 540 Seriously Ill Older Adults: Effects of Increasing Age on Clinical Outcomes and Survival , 2014, Journal of the American Geriatrics Society.

[6]  J. Ibáñez,et al.  CO2 Response and Duration of Weaning From Mechanical Ventilation , 2011, Respiratory Care.

[7]  M. Decramer,et al.  Increased duration of mechanical ventilation is associated with decreased diaphragmatic force: a prospective observational study , 2010, Critical care.

[8]  S. Powers,et al.  Prolonged mechanical ventilation alters diaphragmatic structure and function , 2009, Critical care medicine.

[9]  J. Ibáñez,et al.  Hypercapnia Test and Weaning outcome from Mechanical Ventilation in COPD Patients , 2009, Anaesthesia and intensive care.

[10]  C. Campillo,et al.  Hypercapnia test as a predictor of success in spontaneous breathing trials and extubation. , 2008, Respiratory care.

[11]  B. Marsh,et al.  Weaning from mechanical ventilation , 2007, European Respiratory Journal.

[12]  H. Kuo,et al.  Experience with a step-down respiratory care center at a tertiary referral medical center in Taiwan. , 2006, Journal of critical care.

[13]  Sean Muldoon,et al.  Management of patients requiring prolonged mechanical ventilation: report of a NAMDRC consensus conference. , 2005, Chest.

[14]  Gary C Sieck,et al.  Altered diaphragm contractile properties with controlled mechanical ventilation. , 2002, Journal of applied physiology.

[15]  D. Johns,et al.  Peripheral and central ventilatory responses in central sleep apnea with and without congestive heart failure. , 2000, American journal of respiratory and critical care medicine.

[16]  C. Gallagher,et al.  Ventilatory responses to hypercapnia and hypoxia in relatives of patients with the obesity hypoventilation syndrome , 2000, Thorax.

[17]  T. Busso,et al.  Analysis of end-tidal and arterial PCO2 gradients using a breathing model , 2000, European Journal of Applied Physiology.

[18]  John F. Murray Md DSc Frcp,et al.  Textbook of Respiratory Medicine , 2000 .

[19]  M. Younes,et al.  Effects of inspiratory muscle unloading on the response of respiratory motor output to CO2. , 1997, American journal of respiratory and critical care medicine.

[20]  M J Tobin,et al.  Pathophysiologic basis of acute respiratory distress in patients who fail a trial of weaning from mechanical ventilation. , 1997, American journal of respiratory and critical care medicine.

[21]  D. Cunningham,et al.  Estimation of arterial PCO2 in the elderly. , 1995, Journal of applied physiology.

[22]  J. Roustan,et al.  Occlusion pressure and its ratio to maximum inspiratory pressure are useful predictors for successful extubation following T-piece weaning trial. , 1995, Chest.

[23]  F. Lemaire,et al.  Principles and practice of mechanical ventilation , 1995, Intensive Care Medicine.

[24]  C. K. Mahutte,et al.  Airway occlusion pressure and breathing pattern as predictors of weaning outcome. , 1993, The American review of respiratory disease.

[25]  M. Cupa,et al.  Effects of doxapram on hypercapnic response during weaning from mechanical ventilation in COPD patients. , 1992, Chest.

[26]  F. Bellemare,et al.  Effect of lung volume on in vivo contraction characteristics of human diaphragm. , 1987, Journal of applied physiology.

[27]  D. Pierson,et al.  Prediction of successful ventilator weaning using airway occlusion pressure and hypercapnic challenge. , 1987, Chest.

[28]  N. Jones,et al.  Difference between end-tidal and arterial PCO2 in exercise. , 1979, Journal of applied physiology: respiratory, environmental and exercise physiology.

[29]  D. Read,et al.  Blood-brain tissue Pco2 relationships and ventilation during rebreathing. , 1967, Journal of applied physiology.

[30]  Read Dj,et al.  A clinical method for assessing the ventilatory response to carbon dioxide. , 1967 .

[31]  J. Severinghaus,et al.  Respiratory responses mediated through superficial chemosensitive areas on the medulla , 1963, Journal of applied physiology.

[32]  B. Shia,et al.  Response to hypercapnic challenge is associated with successful weaning from prolonged mechanical ventilation due to brain stem lesions , 2008, Intensive Care Medicine.

[33]  D. Read,et al.  A clinical method for assessing the ventilatory response to carbon dioxide. , 1967, Australasian annals of medicine.