Effect of ventilator mode on sleep quality in critically Ill patients
Effect of ventilator mode on sleep quality in critically Ill patients
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DOI：
10.1164/rccm.200209-999oc
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发表时间：
2002-12-01
影响因子：
24.7
通讯作者：
Tobin, MJ
中科院分区：
文献类型：
--
作者：
Parthasarathy, S;Tobin, MJ
为了确定机械通气方式是否影响睡眠质量，我们对11例危重患者进行了多导睡眠描记术。由于压力支持在健康受试者中易导致中枢性呼吸暂停，我们研究了辅助控制通气的备份率是否会减少呼吸暂停相关的唤醒并改善睡眠质量。以觉醒和觉醒次数来衡量的睡眠碎片化，在压力支持下比辅助控制通气时更大：每小时779次vs 54次+/- 7次（p = 0.02）。6例患者在压力支持期间发生中枢性呼吸暂停；这6例患者的心力衰竭比5例无呼吸暂停的患者更常见：83%比20% （p = 0.04）。在中枢性呼吸暂停患者中，增加死亡空间减少睡眠碎片：每小时44 +/- 6次与83 +/- 12次唤醒和觉醒（p = 0.02）。与辅助控制通气相比，压力支持时睡眠-觉醒状态的变化导致呼吸成分和尾潮CO2的变化更大。综上所述，压力支持的吸气辅助会导致低碳酸血症，再加上缺乏备份率和清醒驱动，会导致中枢性呼吸暂停和睡眠断裂，尤其是在心力衰竭患者中。
To determine whether sleep quality is influenced by the mode of mechanical ventilation, we performed polysomnography on 11 critically ill patients. Because pressure support predisposes to central apneas in healthy subjects, we examined whether the presence of a backup rate on assist-control ventilation would decrease apnea-related arousals and improve sleep quality. Sleep fragmentation, measured as the number of arousals and awakenings, was greater during pressure support than during assist-control ventilation: 79 7 versus 54 +/- 7 events per hour (p = 0.02). Central apneas occurred during pressure support in six patients; heart failure was more common in these six patients than in the five patients without apneas: 83 versus 20% (p = 0.04). Among patients with central apneas, adding dead space decreased sleep fragmentation: 44 +/- 6 versus 83 +/- 12 arousals and awakenings per hour (p = 0.02). Changes in sleep-wakefulness state caused greater changes in breath components and end-tidal CO2 during pressure support than during assist-control ventilation. In conclusion, inspiratory assistance from pressure support causes hypocapnia, which combined with the lack of a backup rate and wakefulness drive can lead to central apneas and sleep fragmentation, especially in patients with heart failure.