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Sci Rep. 2019 Nov 12;9(1):16572. doi: 10.1038/s41598-019-53152-y.

Adjusting ventilator settings to relieve dyspnoea modifies brain activity in critically ill patients: an electroencephalogram pilot study.

Author information

1
Sorbonne Université, INSERM UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France.
2
AP-HP, Groupe Hospitalier Pitié Salpêtrière - Charles Foix, Département d'Anesthésie-Réanimation, F-75013, Paris, France.
3
Sorbonne Université, INSERM UMR 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle Épinière, Paris, France.
4
AP-HP, Groupe Hospitalier Pitié Salpêtrière - Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, F-75013, Paris, France.
5
Sorbonne Université, INSERM UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, F-75005, Paris, France. thomas.similowski@upmc.fr.
6
AP-HP, Groupe Hospitalier Pitié Salpêtrière - Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, F-75013, Paris, France. thomas.similowski@upmc.fr.

Abstract

Dyspnoea is frequent and distressing in patients receiving mechanical ventilation, but it is often not properly evaluated by caregivers. Electroencephalographic signatures of dyspnoea have been identified experimentally in healthy subjects. We hypothesized that adjusting ventilator settings to relieve dyspnoea in MV patients would induce EEG changes. This was a first-of-its-kind observational study in a convenience population of 12 dyspnoeic, mechanically ventilated patients for whom a decision to adjust the ventilator settings was taken by the physician in charge (adjustments of pressure support, slope, or trigger). Pre- and post-ventilator adjustment electroencephalogram recordings were processed using covariance matrix statistical classifiers and pre-inspiratory potentials. The pre-ventilator adjustment median dyspnoea visual analogue scale was 3.0 (interquartile range: 2.5-4.0; minimum-maximum: 1-5) and decreased by (median) 3.0 post-ventilator adjustment. Statistical classifiers adequately detected electroencephalographic changes in 8 cases (area under the curve ≥0.7). Previously present pre-inspiratory potentials disappeared in 7 cases post-ventilator adjustment. Dyspnoea improvement was consistent with electroencephalographic changes in 9 cases. Adjusting ventilator settings to relieve dyspnoea produced detectable changes in brain activity. This paves the way for studies aimed at determining whether monitoring respiratory-related electroencephalographic activity can improve outcomes in critically ill patients under mechanical ventilation.

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