CARdIAC dysRHyTHMIAs dURINg WEANINg FROM MECHANICAL VENTILATION

Background Weaning from mechanical ventilation to spontaneous breathing is associated with changes in the hemodynamic and autonomic nervous systems that are reflected by heart rate variability. Although cardiac dysrhythmias are an important manifestation of hemodynamic alterations, the impact of heart rate variability on the occurrence of dysrhythmias during weaning has not been specifically studied. Objectives To describe differences in heart rate variability spectral power and occurrence of cardiac dysrhythmias at baseline and during the initial trial of weaning from mechanical ventilation and to evaluate the impact of heart rate variability during weaning on occurrence of dysrhythmias. Method Continuous 3-lead electrocardiographic recordings were collected from 35 patients receiving mechanical ventilation for 24 hours at baseline and during the initial weaning trial. Heart rate variability was evaluated by using spectral power analysis. Results Low-frequency power increased (P= .04) and highfrequency and very-low-frequency power did not change during weaning. The mean number of supraventricular ectopic beats per hour during weaning was higher than the mean at baseline (P< .001); the mean of ventricular ectopic beats did not change. Low-frequency power was a predictor of ventricular and supraventricular ectopic beats during weaning (P< .001). High-frequency power was predictive of ventricular and supraventricular (P= .02) ectopic beats during weaning. Verylow-frequency power was predictive of ventricular ectopic beats (P< .001) only. Conclusion Heart rate variability power spectra during weaning were predictive of dysrhythmias. (American Journal of Critical Care. 2015;24:118-127) HEART RATE VARIAbILITy As A PREdICTOR OF CARdIAC dysRHyTHMIAs dURINg WEANINg FROM MECHANICAL VENTILATION