Annals of the Russian academy of medical sciencesAnnals of the Russian academy of medical sciences0869-60472414-3545"Paediatrician" Publishers LLC120310.15690/vramn1203Research ArticlePrediction of the effectiveness of spontaneous breathing in patients with brain damage of various etiologiesKiryachkovYuri Y.<p>MD, PhD</p>kirychyu@yandex.ruhttps://orcid.org/0000-0001-5113-199XPetrovaMarina V.<p>MD, PhD, Professor</p>mail@petrovamv.ruhttps://orcid.org/0000-0003-4272-0957ParfenovAlexandr L.<p>MD, PhD</p>alpar45@mail.ruhttps://orcid.org/0000-0002-5012-0516LoginovAnatoly A.dr.loginovalexey@yandex.ruhttps://orcid.org/0000-0002-5080-3245SkvortsovArtem E.artskvor@bk.ruhttps://orcid.org/0000-0003-0759-5054Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology211220197463713771509201925112019Copyright © 2019, "Paediatrician" Publishers LLC2019<p><strong>BACKGROUND</strong>: Long-term respiratory support is a severe disabling factor and is accompanied by a long stay of patients in intensive care units.</p>
<p><strong>AIMS</strong>: The analysis of the predictors of the success of disconnection from mechanical ventilation on the basis of clinical and diagnostic criteria in patients with brain damage of various etiologies.</p>
<p><strong>METHODS</strong>: The study included 53 patients (husband ― 28, women ― 25; cf. age 53.69 2.34) who are in 2019 with the consequences of traumatic brain injury (TBI) (n = 18; 33.9%); consequences of acute cerebrovascular accident (n = 24; 45.3%); the effects of anoxic brain damage (n = 3; 5.7%); consequences of subarachnoid hemorrhage (n = 8; 15.1%).</p>
<p><strong>RESULTS</strong>: The statistically significant predictor of recovery of spontaneous breathing in the 1st and 2nd groups of patients were preserved chemoreflex sensitivity (IPCS), the sensitivity and specificity of IPCS was 78.57% [95 % DI 49.295.26] and 83.3 % [95 % CI 62.695.26]. The index of peripheral chemoreflex sensitivity (IPCS) was calculated using the formula: IPCS = [RRe / RRi] [Vt(e) / Vt(i)] [VE(e) / VE(i)] [Vt(e) VE(i)], where IPCS is the index of peripheral chemoreflex sensitivity in l/min; RRi and RRe; Vt(i) and Vt(e); VE(e) and VE(i) ― respiratory rate (RR, breaths/min), tidal volume (Vt), minute ventilation (VE), (l/min) of the starting point ― (i) before carrying out a functional stress test and (e) ― during a functional test of normobaric hypoxia with SpO<sub>2</sub> in the range of 9080 %.</p>
<p><strong>CONCLUSIONS</strong>: The most significant clinical parameters statistically reliably hampering the process of successful recovery of spontaneous breathing in addition to chemoreflex sensitivity are the presence of severe heart failure, pneumonia, autonomic dysfunction, level of consciousness, age, higher levels of inspiratory and expiratory pressure mounted on a respirator.</p>peripheral chemoreflex sensitivityweaning from mechanical ventilationfunctional stress testrecovery of spontaneous breathingхеморефлекторная чувствительностьфункциональная нагрузочная пробавосстановления самостоятельного дыхания[Wunsch H, Linde-Zwirble WT, Angus DC, et al. The epidemiology of mechanical ventilation uses in the United States. Crit Care Med. 2010;38(10):1947−1953. doi: 10.1097/CCM.0b013e3181ef4460.][Tubek S, Niewinski P, Reczuch K, et al. Effects of selective carotid body stimulation with adenosine in conscious humans. J Physiol. 2016;594(21):6225−6240. doi: 10.1113/JP272109.][Miller AJ, Sauder CL, Cauffman AE, et al. Endurance training attenuates the increase in peripheral chemoreflex sensitivity with intermittent hypoxia. Am J Physiol Regul Integr Comp Physiol. 2017;312(2): R223−R228. doi: 10.1152/ajpregu.00105.2016.][Mansukhani MP, Wang S, Somers VK Chemoreflex physiology and implications for sleep apnoea: insights from studiesin humans. Exp Physiol. 2015;100(2):130−135. doi: 10.1113/expphysiol.2014.082826.][Toledo C, Andrade DC, Lucero C, et al. Contribution of peripheral and central chemoreceptors to sympatho-excitation in heart failure. J Physiol. 2017;595(1):43−51. doi: 10.1113/JP272075.][Andrade DC, Arce-Alvarez A, Toledo C, et al. Revisiting the physiological effects of exercise training on autonomic regulation and chemoreflex control in heart failure: does ejection fraction matter? Am J Physiol Heart Circ Physiol. 2018;314(3):H464−H474. doi: 10.1152/ajpheart.00407.2017.][Iturriaga R. Carotid body ablation: a new target to address central autonomic dysfunction. Curr Hypertens Rep. 2018;20(6):53. doi: 10.1007/s11906-018-0849-z.][Zera T, Moraes DYa, da Silva MP, et al. The logic of carotid body connectivity to the brain. Physiology (Bethesda). 2019;34(4):264−282. doi: 10.1152/physiol.00057.2018.][Keir DA, Duffin J, Millar PJ, Floras JS. Simultaneous assessment of central and peripheral chemoreflex regulation of muscle sympathetic nerve activity and ventilation in healthy young men. J Physiol. 2019;597(13):3281−3296. doi: 10.1113/JP277691.][Limberg JK. Glucose, insulin, and the carotid body chemoreceptors in humans. Physiol Genomics. 2018;50(7):504−509. doi: 10.1152/physiolgenomics.00032.2018.][Lee CS, Chen NH, Chuang LP, et al. Hypercapnic ventilatory response in the weaning of patients with prolonged mechanical ventilation. Can Respir J. 2017;2017:7381424. doi: 10.1155/2017/7381424.]