Costa Roberta, Navalesi Paolo, Cammarota Gianmaria, Longhini Federico, Spinazzola Giorgia, Cipriani Flora, Ferrone Giuliano, Festa Olimpia, Antonelli Massimo, Conti Giorgio
Department of Anesthesia and Intensive Care, Catholic University of Rome, Largo Agostino Gemelli 1, 00135 Rome, Italy.
Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
Respir Physiol Neurobiol. 2017 Oct;244:10-16. doi: 10.1016/j.resp.2017.06.007. Epub 2017 Jul 1.
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·min1) during both PSV and NAVA. We measured the patient's (Ti/Ttot) and ventilator (Ti/Ttot) duty cycle, the Electrical Activity of the Diaphragm (EAdi), the inspiratory (Delay) and expiratory (Delay) 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/min produced a significant reduction of Ti/Ttot and Ti/Ttot by prolonging the expiratory time. Delay and Delay 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.
我们评估了不同剂量瑞芬太尼对接受压力支持通气（PSV）和神经调节通气辅助（NAVA）的患者呼吸驱动及时间的影响。在PSV和NAVA期间，对13例插管患者随机给予四剂递增的瑞芬太尼（0.03、0.05、0.08和0.1μg·Kg·min⁻¹）。我们测量了患者的（吸气时间/总呼吸周期时间）（Ti/Ttot）和呼吸机的（Ti/Ttot）占空比、膈肌电活动（EAdi）、吸气触发延迟（Delay）和呼气触发延迟（Delay）以及不同步指数（AI）。无论通气模式如何，递增剂量的瑞芬太尼均未改变EAdi。与基线相比，输注瑞芬太尼>0.05μg/Kg/min通过延长呼气时间使Ti/Ttot和Ti/Ttot显著降低。与PSV相比，NAVA中的吸气触发延迟和呼气触发延迟明显更短。不同剂量的瑞芬太尼对AI没有影响，但与PSV相比，NAVA期间AI显著更低。总之，瑞芬太尼不影响呼吸驱动，仅影响呼吸时间，且两种模式之间无差异。
