RT Journal Article
SR Electronic
T1 Remifentanil Improves Breathing Pattern and Reduces Inspiratory Workload in Tachypneic Patients
JF Respiratory Care
FD American Association for Respiratory Care
SP 827
OP 833
DO 10.4187/respcare.01014
VO 56
IS 6
A1 Giuseppe Natalini
A1 Antonella Di Maio
A1 Antonio Rosano
A1 Pierluigi Ferretti
A1 Michele Bertelli
A1 Achille Bernardini
YR 2011
UL http://rc.rcjournal.com/content/56/6/827.abstract
AB BACKGROUND: Properly titrated opiates decrease respiratory rate but do not affect tidal volume or induce respiratory acidosis. OBJECTIVE: To determine whether remifentanil improves breathing pattern or reduces inspiratory effort in patients with acute respiratory failure and tachypnea or rapid shallow breathing. METHODS: We studied 14 patients who developed tachypnea and/or rapid shallow breathing if the pressure support level was reduced. During pressure support ventilation, each patient received 30-min infusions, separated by 30 min, of remifentanil and placebo. Measurements were obtained before commencing and before stopping each infusion, and after 3 min of unassisted breathing. The main outcomes were rapid shallow breathing index and change in pressure-time product. RESULTS: Remifentanil did not significantly affect tidal volume. During pressure support ventilation, remifentanil infusion reduced respiratory rate, pressure-time product, and cardiovascular double product (heart rate × systolic arterial pressure) without modifying the sedation score. Mean PaCO2 showed a small and clinically negligible increase during remifentanil, but PaCO2 increased more in the hypercapnic patients than in the normocapnic patients. Remifentanil reduced the rapid shallow breathing index after 3 min of unassisted breathing. CONCLUSIONS: Remifentanil improved respiratory pattern and decreased inspiratory muscles effort in patients with tachypnea or rapid shallow breathing, but did not affect oxygenation or sedation. Though the acid-base balance did not show clinically relevant changes on average, we cannot exclude the possibility that remifentanil might prolong weaning in hypercapnic patients. (ClinicalTrials.gov registration NCT00665119)