Application of Heart-rate Variability in Patients Undergoing Weaning from Mechanical Ventilation

Overview

Journal Crit Care

Specialty Critical Care

Date 2014 Jan 25

PMID 24456585

Citations 19

Authors

Chun-Ta Huang

Yi-Ju Tsai

Jou-Wei Lin

Sheng-Yuan Ruan

Huey-Dong Wu

Chong-Jen Yu

Affiliations

Soon will be listed here.

Abstract

Introduction: 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.

Methods: This 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.

Results: Of 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.

Conclusions: HRV 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.

Citing Articles

Heart Rate Variability During Weaning from Invasive Mechanical Ventilation: A Systematic Review.

Giordano G, Alessandri F, Tosi A, Zullino V, Califano L, Petramala L J Clin Med. 2025; 13(24.

PMID: 39768558 PMC: 11727775. DOI: 10.3390/jcm13247634.

Predictors of weaning failure in ventilated intensive care patients: a systematic evidence map.

Sterr F, Reintke M, Bauernfeind L, Senyol V, Rester C, Metzing S Crit Care. 2024; 28(1):366.

PMID: 39533438 PMC: 11556093. DOI: 10.1186/s13054-024-05135-3.

Defining predictors for successful mechanical ventilation weaning, using a data-mining process and artificial intelligence.

Menguy J, de Longeaux K, Bodenes L, Hourmant B, LHer E Sci Rep. 2023; 13(1):20483.

PMID: 37993526 PMC: 10665387. DOI: 10.1038/s41598-023-47452-7.

Clinical surrogates of dysautonomia predict lethal outcome in COVID-19 on intensive care unit.

Woo M, Mayer C, Fischer M, Kluge S, Roedl K, Gerloff C Neurol Res Pract. 2023; 5(1):17.

PMID: 37143130 PMC: 10157117. DOI: 10.1186/s42466-023-00243-x.

Early heart rate variability evaluation enables to predict ICU patients' outcome.

Bodenes L, NGuyen Q, Le Mao R, Ferriere N, Pateau V, Lellouche F Sci Rep. 2022; 12(1):2498.

PMID: 35169170 PMC: 8847560. DOI: 10.1038/s41598-022-06301-9.

References

Esteban A, Alia I, Gordo F, Fernandez R, Solsona J, Vallverdu I . Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation. The Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med. 1997; 156(2 Pt 1):459-65. DOI: 10.1164/ajrccm.156.2.9610109. View

Macintyre N, Cook D, Ely Jr E, Epstein S, FINK J, Heffner J . Evidence-based guidelines for weaning and discontinuing ventilatory support: a collective task force facilitated by the American College of Chest Physicians; the American Association for Respiratory Care; and the American College of Critical Care.... Chest. 2001; 120(6 Suppl):375S-95S. DOI: 10.1378/chest.120.6_suppl.375s. View

COUMEL P, Hermida J, Wennerblom B, Leenhardt A, Maison-Blanche P, Cauchemez B . Heart rate variability in left ventricular hypertrophy and heart failure, and the effects of beta-blockade. A non-spectral analysis of heart rate variability in the frequency domain and in the time domain. Eur Heart J. 1991; 12(3):412-22. DOI: 10.1093/oxfordjournals.eurheartj.a059910. View

Wysocki M, Cracco C, Teixeira A, Mercat A, Diehl J, Lefort Y . Reduced breathing variability as a predictor of unsuccessful patient separation from mechanical ventilation. Crit Care Med. 2006; 34(8):2076-83. DOI: 10.1097/01.CCM.0000227175.83575.E9. View

Esteban A, Alia I, Tobin M, Gil A, Gordo F, Vallverdu I . Effect of spontaneous breathing trial duration on outcome of attempts to discontinue mechanical ventilation. Spanish Lung Failure Collaborative Group. Am J Respir Crit Care Med. 1999; 159(2):512-8. DOI: 10.1164/ajrccm.159.2.9803106. View

Mastorakos G, Pavlatou M . Exercise as a stress model and the interplay between the hypothalamus-pituitary-adrenal and the hypothalamus-pituitary-thyroid axes. Horm Metab Res. 2005; 37(9):577-84. DOI: 10.1055/s-2005-870426. View

Shen H, Lin L, Chen K, Kuo P, Yu C, Wu H . Changes of heart rate variability during ventilator weaning. Chest. 2003; 123(4):1222-8. DOI: 10.1378/chest.123.4.1222. View

Vassilakopoulos T, Zakynthinos S, Roussos C . Respiratory muscles and weaning failure. Eur Respir J. 1996; 9(11):2383-400. DOI: 10.1183/09031936.96.09112383. View

Jacob B, Chatila W, Manthous C . The unassisted respiratory rate/tidal volume ratio accurately predicts weaning outcome in postoperative patients. Crit Care Med. 1997; 25(2):253-7. DOI: 10.1097/00003246-199702000-00010. View

10.

Jubran A, Tobin M . Pathophysiologic basis of acute respiratory distress in patients who fail a trial of weaning from mechanical ventilation. Am J Respir Crit Care Med. 1997; 155(3):906-15. DOI: 10.1164/ajrccm.155.3.9117025. View

11.

Brack T, Jubran A, Tobin M . Effect of resistive loading on variational activity of breathing. Am J Respir Crit Care Med. 1998; 157(6 Pt 1):1756-63. DOI: 10.1164/ajrccm.157.6.9704114. View

12.

Thille A, Harrois A, Schortgen F, Brun-Buisson C, Brochard L . Outcomes of extubation failure in medical intensive care unit patients. Crit Care Med. 2011; 39(12):2612-8. DOI: 10.1097/CCM.0b013e3182282a5a. View

13.

Vassilakopoulos T, Zakynthinos S, Roussos C . The tension-time index and the frequency/tidal volume ratio are the major pathophysiologic determinants of weaning failure and success. Am J Respir Crit Care Med. 1998; 158(2):378-85. DOI: 10.1164/ajrccm.158.2.9710084. View

14.

Malpas S . Neural influences on cardiovascular variability: possibilities and pitfalls. Am J Physiol Heart Circ Physiol. 2001; 282(1):H6-20. DOI: 10.1152/ajpheart.2002.282.1.H6. View

15.

Aarimaa T, Oja R, Antila K, Valimaki I . Interaction of heart rate and respiration in newborn babies. Pediatr Res. 1988; 24(6):745-50. DOI: 10.1203/00006450-198812000-00019. View

16.

La Rovere M, Pinna G, Maestri R, Mortara A, Capomolla S, Febo O . Short-term heart rate variability strongly predicts sudden cardiac death in chronic heart failure patients. Circulation. 2003; 107(4):565-70. DOI: 10.1161/01.cir.0000047275.25795.17. View

17.

Chatila W, Jacob B, Guaglionone D, Manthous C . The unassisted respiratory rate-tidal volume ratio accurately predicts weaning outcome. Am J Med. 1996; 101(1):61-7. DOI: 10.1016/s0002-9343(96)00064-2. View

18.

Boles J, Bion J, Connors A, Herridge M, Marsh B, Melot C . Weaning from mechanical ventilation. Eur Respir J. 2007; 29(5):1033-56. DOI: 10.1183/09031936.00010206. View

19.

Tobin M, Mador M, Guenther S, Lodato R, SACKNER M . Variability of resting respiratory drive and timing in healthy subjects. J Appl Physiol (1985). 1988; 65(1):309-17. DOI: 10.1152/jappl.1988.65.1.309. View

20.

MacIntyre N . Discontinuing mechanical ventilatory support. Chest. 2007; 132(3):1049-56. DOI: 10.1378/chest.06-2862. View