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Respir Physiol Neurobiol. 2017 Oct;244:10-16. doi: 10.1016/j.resp.2017.06.007. Epub 2017 Jul 1.

Remifentanil effects on respiratory drive and timing during pressure support ventilation and neurally adjusted ventilatory assist.

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Department of Anesthesia and Intensive Care, Catholic University of Rome, Largo Agostino Gemelli 1, 00135 Rome, Italy.
Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.
Anesthesia and Intensive Care, "Maggiore Della Carità" Hospital, Novara, Italy.
Anesthesia and Intensive Care, Sant'Andrea Hospital, ASL VC, Vercelli, Italy. Electronic address:


We assessed the effects of varying doses of remifentanil on respiratory drive and timing in patients receiving Pressure Support Ventilation (PSV) and Neurally Adjusted Ventilatory Assist (NAVA). Four incrementing remifentanil doses were randomly administered to thirteen intubated patients (0.03, 0.05, 0.08, and 0.1μg·Kg-1·min-1) during both PSV and NAVA. We measured the patient's (Ti/Ttotneu) and ventilator (Ti/Ttotmec) duty cycle, the Electrical Activity of the Diaphragm (EAdi), the inspiratory (Delaytrinsp) and expiratory (Delaytrexp) trigger delays and the Asynchrony Index (AI). Increasing doses of remifentanil did not modify EAdi, regardless the ventilatory mode. In comparison to baseline, remifentanil infusion >0.05μg/Kg-1/min-1 produced a significant reduction of Ti/Ttotneu and Ti/Ttotmec, by prolonging the expiratory time. Delaytrinsp and Delaytrexp were significantly shorter in NAVA, respect to PSV. AI was not influenced by the different doses of remifentanil, but it was significantly lower during NAVA, compared to PSV. In conclusion remifentanil did not affect the respiratory drive, but only respiratory timing, without differences between modes.


NAVA; PSV; Remifentanil; Respiratory drive; Respiratory timing; Sedation

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