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BMC Physiology
Published in: BMC Physiology 1/2011

Open Access 01-12-2011 | Research article

Study of multiparameter respiratory pattern complexity in surgical critically ill patients during weaning trials

Authors: Vasilios E Papaioannou, Ioanna G Chouvarda, Nikos K Maglaveras, Ioannis A Pneumatikos

Published in: BMC Physiology | Issue 1/2011

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Abstract

Background

Separation from mechanical ventilation is a difficult task, whereas conventional predictive indices have not been proven accurate enough, so far. A few studies have explored changes of breathing pattern variability for weaning outcome prediction, with conflicting results. In this study, we tried to assess respiratory complexity during weaning trials, using different non-linear methods derived from theory of complex systems, in a cohort of surgical critically ill patients.

Results

Thirty two patients were enrolled in the study. There were 22 who passed and 10 who failed a weaning trial. Tidal volume and mean inspiratory flow were analyzed for 10 minutes during two phases: 1. pressure support (PS) ventilation (15-20 cm H2O) and 2. weaning trials with PS: 5 cm H2O. Sample entropy (SampEn), detrended fluctuation analysis (DFA) exponent, fractal dimension (FD) and largest lyapunov exponents (LLE) of the two respiratory parameters were computed in all patients and during the two phases of PS. Weaning failure patients exhibited significantly decreased respiratory pattern complexity, reflected in reduced sample entropy and lyapunov exponents and increased DFA exponents of respiratory flow time series, compared to weaning success subjects (p < 0.001). In addition, their changes were opposite between the two phases of the weaning trials. A new model including rapid shallow breathing index (RSBI), its product with airway occlusion pressure at 0.1 sec (P0.1), SampEn and LLE predicted better weaning outcome compared with RSBI, P0.1 and RSBI* P0.1 (conventional model, R2 = 0.874 vs 0.643, p < 0.001). Areas under the curve were 0.916 vs 0.831, respectively (p < 0.05).

Conclusions

We suggest that complexity analysis of respiratory signals can assess inherent breathing pattern dynamics and has increased prognostic impact upon weaning outcome in surgical patients.
Appendix
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Metadata
Title
Study of multiparameter respiratory pattern complexity in surgical critically ill patients during weaning trials
Authors
Vasilios E Papaioannou
Ioanna G Chouvarda
Nikos K Maglaveras
Ioannis A Pneumatikos
Publication date
01-12-2011
Publisher
BioMed Central
Published in
BMC Physiology / Issue 1/2011
Electronic ISSN: 1472-6793
DOI
https://doi.org/10.1186/1472-6793-11-2

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