Remifentanil effects on respiratory drive and timing during pressure support ventilation and neurally adjusted ventilatory assist

Respir Physiol Neurobiol. 2017 Oct;244:10-16. doi: 10.1016/j.resp.2017.06.007. Epub 2017 Jul 1.

Abstract

We assessed the effects of varying doses of remifentanil on respiratory drive and timing in patients receiving Pressure Support Ventilation (PSV) and Neurally Adjusted Ventilatory Assist (NAVA). Four incrementing remifentanil doses were randomly administered to thirteen intubated patients (0.03, 0.05, 0.08, and 0.1μg·Kg-1·min-1) during both PSV and NAVA. We measured the patient's (Ti/Ttotneu) and ventilator (Ti/Ttotmec) duty cycle, the Electrical Activity of the Diaphragm (EAdi), the inspiratory (Delaytrinsp) and expiratory (Delaytrexp) trigger delays and the Asynchrony Index (AI). Increasing doses of remifentanil did not modify EAdi, regardless the ventilatory mode. In comparison to baseline, remifentanil infusion >0.05μg/Kg-1/min-1 produced a significant reduction of Ti/Ttotneu and Ti/Ttotmec, by prolonging the expiratory time. Delaytrinsp and Delaytrexp were significantly shorter in NAVA, respect to PSV. AI was not influenced by the different doses of remifentanil, but it was significantly lower during NAVA, compared to PSV. In conclusion remifentanil did not affect the respiratory drive, but only respiratory timing, without differences between modes.

Keywords: NAVA; PSV; Remifentanil; Respiratory drive; Respiratory timing; Sedation.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Critical Care
  • Cross-Over Studies
  • Dose-Response Relationship, Drug
  • Female
  • Humans
  • Hypnotics and Sedatives / therapeutic use*
  • Male
  • Middle Aged
  • Piperidines / therapeutic use*
  • Remifentanil
  • Respiration, Artificial*
  • Respiratory Mechanics / drug effects*
  • Respiratory Mechanics / physiology
  • Time Factors

Substances

  • Hypnotics and Sedatives
  • Piperidines
  • Remifentanil