High respiratory effort decreases splanchnic and peripheral perfusion in patients with respiratory failure during mechanical ventilation |
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| Affiliation: | 1. Department of Intensive Care, Royal Melbourne Hospital, Melbourne, Australia;2. Department of Intensive Care, Austin Hospital, Melbourne, Australia;3. Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia;4. Data Analytics Research and Evaluation Centre, Austin Hospital, Melbourne, Australia;5. Department of Critical Care, University of Melbourne, Melbourne, Australia;1. Department of Emergency and Critical Care Medicine, Hitachi General Hospital, 2-1-1, Jonan-cho, Hitachi, Ibaraki 317-0077, Japan;2. Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan;3. Neuroscience Nursing, St. Luke''s International University, Tokyo, Japan;1. Division of Intensive Care, Department of Anaesthesiology and Reanimation, Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey;2. Department of Anaesthesiology and Reanimation, Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey |
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| Abstract: | PurposeThis study aimed to evaluate the effects of high respiratory effort(HRE) on spleen, kidney, intestine, and peripheral perfusion in patients with respiratory failure during mechanical ventilation.MethodsHRE was defined as a pressure muscle index (PMI) > 6 cmH2O and airway pressure swing during occlusion (ΔPOCC) > 10 cmH2O. Capillary refill time(CRT) and peripheral perfusion index (PPI) were determined when HRE occurred. The resistance indices of the snuffbox, intestine, spleen, and kidney were measured using Doppler ultrasonography simultaneously. These parameters were re-measured when the patients had normal respiratory effort (NRE) following sedation and analgesia.ResultsA total of 33 critically ill patients were enrolled in this prospective observational study. There was a significant increase in CRT (p = 0.0345) and PPI (p < 0.0001) from HRE to NRE; meanwhile, the resistance index of the snuffbox artery decreased (p < 0.0001). Regarding splanchnic perfusion indicators, all resistance indices of the superior mesenteric artery (p = 0.0002), spleen (p < 0.0001), and kidney (p < 0.0001) decreased significantly when the patient changed from HRE status to NRE.ConclusionsHRE could decrease perfusion of peripheral tissues and splanchnic organs. The status of HRE should be avoided to protect splanchnic and peripheral organs in mechanically ventilated patients. |
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