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Decreased breathing variability is associated with poorer outcome in mechanically ventilated patients

Camille Rolland-Debord, Tymothee Poitou, Come Bureau, Isabelle Rivals, Thomas Similowski, Alexandre Demoule
ERJ Open Research 2023; DOI: 10.1183/23120541.00544-2022
Camille Rolland-Debord
1AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation (Département R3S), Paris, France.
2Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
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Tymothee Poitou
1AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation (Département R3S), Paris, France.
2Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
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Come Bureau
1AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation (Département R3S), Paris, France.
2Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
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Isabelle Rivals
2Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
3Equipe de Statistique Appliquée, ESPCI Paris, PSL Research University, Paris, France
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Thomas Similowski
2Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
4AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Département R3S, Paris, France
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Alexandre Demoule
1AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive et Réanimation (Département R3S), Paris, France.
2Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
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  • For correspondence: alexandre.demoule@aphp.fr
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Abstract

Rationale: Breathing is a cyclic activity that is by nature variable. Breathing variability is modified in mechanically ventilated (MV) patients.

Objectives: We aimed to evaluate whether decreased variability on the day of transition from assist-control ventilation to a partial mode of assistance was associated with a poorer outcome.

Methods: This was an ancillary study of a multicenter, randomized, controlled trial comparing neurally adjusted ventilatory assist to pressure support ventilation. Flow and the electrical activity of the diaphragm (EAdi) were recorded within 48 h of switching from controlled ventilation to a partial mode of ventilatory assistance.

Measurements: Variability of flow and EAdi-related variables were quantified by the coefficient of variation, the amplitude ratio of the spectrum's first harmonic to its zero-frequency component (H1/DC) and two surrogates of complexity,.

Main Results: Ninety-eight patients ventilated for a median duration of 5 days were included. H1/DC of inspiratory flow and EAdi were lower in survivors than in non-survivors, suggesting a higher breathing variability in this population (for flow, 37% versus 45%, p=0.041; for EAdi, 42% versus 52%, p=0.002). By multivariate analysis, H1/DC of inspiratory EAdi was independently associated with day-28 mortality (odds ratio 1.10, p=0.002). H1/DC of inspiratory EAdi was lower in patients with a duration of MV<8 days (41% versus 45%, p=0.022). Noise limit and the largest Lyapunov exponent suggested a lower complexity in patients with a duration of MV<8 days.

Conclusion: Higher breathing variability and lower complexity are associated with higher survival and lower duration of MV.

Footnotes

This manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.

Conflict of interest: Alexandre Demoule reports grants or contracts from Philips, Fisher & Paykel, French Ministry of Health, Respinor, and Lungpacer, outside the submitted work; consulting fees from Lungpacer, and Respinor, outside the submitted work; payment or honoraria from Fisher & Paykel, Getinge, Lungpacer, Gilead, Lowenstein, and Astra, outside the submitted work; support for attending meetings and/or travel from Lungpacer, outside the submitted work.

Conflict of interest: Thomas Similowski reports grants or contracts from Chiesi France, and Air Liquide Medical Systems, outside the submitted work; consulting fees from AstraZeneca France, Boerhinger Ingelheim France, Novartis France, TEVA France, Chiesi France, Lungpacer Inc., and ADEP Assistance, outside the submitted work; payment or honoraria from AstraZeneca France, Boerhinger Ingelheim France, Novartis France, TEVA France, Chiesi France, Lungpacer Inc., and ADEP Assistance, outside the submitted work.

Conflict of interest: The remaining authors have nothing to disclose.

This is a PDF-only article. Please click on the PDF link above to read it.

  • Received October 26, 2022.
  • Accepted February 9, 2023.
  • Copyright ©The authors 2023
http://creativecommons.org/licenses/by-nc/4.0/

This version is distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0. For commercial reproduction rights and permissions contact permissions{at}ersnet.org

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Decreased breathing variability is associated with poorer outcome in mechanically ventilated patients
Camille Rolland-Debord, Tymothee Poitou, Come Bureau, Isabelle Rivals, Thomas Similowski, Alexandre Demoule
ERJ Open Research Jan 2023, 00544-2022; DOI: 10.1183/23120541.00544-2022

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Decreased breathing variability is associated with poorer outcome in mechanically ventilated patients
Camille Rolland-Debord, Tymothee Poitou, Come Bureau, Isabelle Rivals, Thomas Similowski, Alexandre Demoule
ERJ Open Research Jan 2023, 00544-2022; DOI: 10.1183/23120541.00544-2022
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