Document Detail


Remifentanil Improves Breathing Pattern and Reduces Inspiratory Workload in Tachypneic Patients.
MedLine Citation:
PMID:  21333087     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Properly titrated opiates decrease respiratory rate, neither affecting tidal volume nor inducing respiratory acidosis. We tested the hypothesis that remifentanil could improve breathing pattern and reduce inspiratory effort in patients with acute respiratory failure associated to tachypnea or rapid shallow breathing. METHODS: We enrolled fourteen patients who showed tachypnea and/or rapid shallow breathing if pressure support level was reduced or withdrawn. Each patient received sequential 30-minute infusions of both remifentanil and placebo. The two infusions were separated by 30 minutes. Measurements were obtained before commencement and before the stopping of each infusion during pressure support ventilation. Furthermore respiratory and cardiovascular variables were obtained after three minutes of unassisted breathing. The main outcomes were rapid shallow breathing index and pressure-time product changes associated with remifentanil infusion. RESULTS: Tidal volume was not modified by remifentanil administration. During pressure support ventilation, remifentanil infusion reduced respiratory rate, pressure-time product and cardiovascular double product without modifying the sedation score. PaCO₂ showed a small and clinically neglibile increase during remifentanil infusion on average. Nevertheless PaCO₂ increased more in hypercapnic than normocapnic patients. Rapid shallow breathing index was reduced by remifentanil after three minutes of unassisted breathing. CONCLUSIONS: Remifentanil improved respiratory pattern and decreased inspiratory muscles effort in patients with tachypnea or rapid shallow breathing. Oxygenation and sedation were not modified. Despite acid-base balance did not show clinically relevant changes on average, we cannot exclude that remifentanil could unfavorably impact weaning process in hypercapnic patients.
Authors:
Giuseppe Natalini; Antonella Dimaio; Antonio Rosano; Pierluigi Ferretti; Michele Bertelli; Achille Bernardini
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-2-11
Journal Detail:
Title:  Respiratory care     Volume:  -     ISSN:  0020-1324     ISO Abbreviation:  -     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-2-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7510357     Medline TA:  Respir Care     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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