Year of Publication

2010

Degree Name

Doctor of Philosophy (PhD)

Document Type

Dissertation

College

Nursing

Department

Nursing

First Advisor

Dr. Debra K. Moser

Abstract

The transition from mechanical ventilation (MV) to spontaneous ventilation during weaning is associated with hemodynamic alterations and autonomic nervous system (ANS) alterations (reflected by heart rate variability [HRV]). Although cardiac dysrhythmias are an important manifestation of hemodynamic alterations, development of dysrhythmias during MV and weaning and subsequent impact on length of MV has received little attention.

The purposes of this dissertation were to 1) evaluate the relationship of heart rate variability (HRV) during weaning to the development of cardiac dysrhythmias and 2) determine the relationship of cardiac dysrhythmias to length of MV.

A convenience sample of 35 patients (66.7% men; mean age 53.3 years) who required MV was enrolled in this study. Continuous 3-lead electrocardiographic data were collected for 24 hours at baseline during MV and for the first 2 hours during the initial weaning trial. HRV was evaluated using spectral power analysis.

Twenty- seven patients out of 30 were exposed to a combination of pressure support (8-15 cm H2O) and continuous positive airway pressure 5 cm H2O during weaning trial. Three patients self- extubated and received supplemental oxygen through either a partial rebreathing or non-rebreathing mask. Low frequency (LF) power HRV decreased, while high frequency (HF) and very low frequency (VLF) power HRV did not change during weaning. Multiple regression analyses showed that LF and HF HRV were significant predictors of occurrence of ventricular and supraventricular ectopic beats during weaning, while VLF power predicted occurrence of ventricular ectopic beats only. The mean of occurrence of supraventricular ectopic beats per hour during weaning was double the mean at baseline, while the mean of ventricular ectopic beats per hour did not change. Mean number of supraventricular ectopic beats per hour during weaning was a significant predictor of length of MV.

This dissertation has fulfilled an important gap in the evidence base for cardiac dysrhythmias during weaning from MV. Cardiac dysrhythmias and HRV alterations should be systemically evaluated during MV and weaning trials in order to decrease length of MV.

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Nursing Commons

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