British Journal of Anaesthesia, Vol 82, Issue 4 546-550, Copyright © 1999 by The Board of Management and Trustees of the British Journal of Anaesthesia
P. D. Larsen, E. L. Trent and D. C. Galletly
Cardioventilatory coupling (CVC) is the temporal coherence of respiratory
and cardiac rhythms. We have suggested that this coherence is the result of
triggering of inspiratory onset by a preceding cardiovascular afferent. One
implication of this triggering hypothesis is that coupling should only
exist under conditions of spontaneous ventilation and not under conditions
where the ventilatory period is fixed, as during intermittent positive
pressure ventilation (IPPV). This study compared the degree of CVC in 20
ASA I female subjects, aged 21-50 yr, 10 of whom were breathing
spontaneously and 10 were undergoing mechanical ventilation. Over 5-10 min,
we recorded the timing of consecutive ECG R waves and inspiratory onsets.
Coupling was demonstrated by examining these epochs for constant timing
relationship between R waves and inspiration (RI intervals). Constancy of
RI intervals was examined graphically (RI plot) and quantitatively using
the Shannon entropy of RI interval distribution. We observed CVC in all
spontaneously breathing subjects but in none of those receiving IPPV. In
spontaneously breathing subjects, temporal alignment with inspiratory onset
was greatest for the heart beat preceding inspiration. We conclude that
although coupling has been shown to persist in the presence of electrical
cardiac pacing, IPPV disrupts the coupling process, consistent with the
view that in anaesthetized subjects, coupling is the triggering of
inspiratory onset by a preceding heart beat and not the converse.
CLINICAL INVESTIGATIONS
Cardioventilatory coupling: effects of IPPV
Section of Anaesthesia, Wellington School of Medicine, PO Box 7343, Wellington South, New Zealand
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