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Cardiorespiratory coupling in mechanically ventilated patients studied via synchrogram analysis

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Abstract

Respiration and cardiac activity are strictly interconnected with reciprocal influences. They act as weakly coupled oscillators showing varying degrees of phase synchronization and their interactions are affected by mechanical ventilation. The study aims at differentiating the impact of three ventilatory modes on the cardiorespiratory phase coupling in critically ill patients. The coupling between respiration and heartbeat was studied through cardiorespiratory phase synchronization analysis carried out via synchrogram during pressure control ventilation (PCV), pressure support ventilation (PSV), and neurally adjusted ventilatory assist (NAVA) in critically ill patients. Twenty patients were studied under all the three ventilatory modes. Cardiorespiratory phase synchronization changed significantly across ventilatory modes. The highest synchronization degree was found during PCV session, while the lowest one with NAVA. The percentage of all epochs featuring synchronization regardless of the phase locking ratio was higher with PCV (median: 33.9%, first–third quartile: 21.3–39.3) than PSV (median: 15.7%; first–third quartile: 10.9–27.8) and NAVA (median: 3.7%; first–third quartile: 3.3–19.2). PCV induces a significant amount of cardiorespiratory phase synchronization in critically ill mechanically ventilated patients. Synchronization induced by patient-driven ventilatory modes was weaker, reaching the minimum with NAVA. Findings can be explained as a result of the more regular and powerful solicitation of the cardiorespiratory system induced by PCV.

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The degree of phase synchronization between cardiac and respiratory activities in mechanically ventilated humans depends on the ventilatory mode

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Author notes

  1. Davide Ottolina and Beatrice Cairo contributed equally to this study.

Authors and Affiliations

  1. Department of Anesthesiology and Intensive Care Unit, ASST Fatebenefratelli Sacco, “Luigi Sacco” Hospital - Polo Universitario, Università degli Studi di Milano, Via G.B. Grassi 74, 20157, Milan, Italy

    Davide Ottolina, Tommaso Fossali, Antonio Castelli, Roberto Rech, Emanuele Catena & Riccardo Colombo

  2. Department of Biomedical Sciences for Health, University of Milan, Milan, Italy

    Beatrice Cairo & Alberto Porta

  3. Department of Electronics Information and Bioengineering, Politecnico di Milano, Milan, Italy

    Claudio Mazzucco

  4. Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy

    Alberto Porta

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  1. Davide Ottolina
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  2. Beatrice Cairo
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Contributions

Conceptualization: TF and RC; data curation: CM, TF, and AP; formal analysis: CM and AP; investigation: DO, TM, AC, and RR; methodology: AP and RC; project administration: EC and RC; resources: EC and RC; software: CM and AP; supervision: AP and RC; validation: BC and AP; visualization: AC and RR; writing original draft: DO; writing—review and editing: BC, AP, and RC.

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Correspondence to Riccardo Colombo.

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Ottolina, D., Cairo, B., Fossali, T. et al. Cardiorespiratory coupling in mechanically ventilated patients studied via synchrogram analysis. Med Biol Eng Comput 61, 1329–1341 (2023). https://doi.org/10.1007/s11517-023-02784-4

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