RT Journal Article
SR Electronic
T1 Profound Bradycardia with Decreased PEEP
JF Respiratory Care
FD American Association for Respiratory Care
SP respcare.02437
DO 10.4187/respcare.02437
A1 Susan R. Wilcox
A1 Ankit Kansagra
A1 Jeremy B. Richards
YR 2013
UL http://rc.rcjournal.com/content/early/2013/04/02/respcare.02437.abstract
AB An athletic 21 year old male was admitted to the Surgical ICU after sustaining 2 stab wounds to his torso. He had an episode of left lung collapse early in his course, managed with suctioning and increased positive end-expiratory pressure (PEEP) to 15cm H2O. He was bradycardic with heart rates between 50-60 beats per minute (bpm) throughout his ICU stay, but when the PEEP was lowered to 5cm H2O in preparation for extubation, he developed sinus pauses and his heart rate dropped to 20bpm. After a thorough evaluation, the drop in his heart rate was determined to be due to increased vagal tone from increased cardiac output with the decreased PEEP. After premedication with glycopyrrolate, he was successfully extubated the following day while his heart rate remained at his baseline of 50bpm. In this case report, we review physiologic mechanisms of bradycardia due to the removal of positive pressure ventilation.