The effects of different weaning modes on the endocrine stress response

Koksal Guniz, Sayilgan Cem, Sen Oznur, Oz, Oz Huseyin

Description

The aim of the present study was to investigate the effects of the stress response on plasma insulin, cortisol, glucose, and urinary vanilmandelic acid during weaning and after extubation, using pressure support (PS), continuous positive airway pressure (CPAP) and T-piece modes. Methods Sixty patients were randomly divided into three groups ( n = 20). The PS group received FiO 2 ≤ 0.4, PS ≤ 10 cmH 2 O, and positive end expiratory pressure ≤ 5 cmH 2 O for 2 hours. The CPAP group was given FiO 2 ≤ 0.4 and CPAP 5 ≤ cmH 2 O for 2 hours. The T-piece group (group T) received 4 l/min oxygen via a T-piece for 2 hours. After 1 hour and 2 hours in their respective weaning modes, blood and urine samples were taken for insulin, cortisol, glucose and vanilmandelic acid measurements. Forty-eight hours after extubation, blood and urine samples were again taken. Results Plasma insulin was greater in group T than in the PS and CPAP groups ( P < 0.01 and P < 0.01). The plasma cortisol concentration was greater in group T than in group PS during weaning ( P < 0.05) and after extubation ( P < 0.05). Blood glucose concentrations were greater in group T than in the other groups (both P < 0.01) both during weaning and post extubation. Urine vanilmandelic acid was greater in group T than in the other groups during weaning and after extubation (both P < 0.001). Conclusion Weaning via the T-piece caused a greater stress response than the PS and CPAP modes.

Sujets

• Cortisol
• Insulin
• Mechanical ventilation
• Fight-or-flight response
• Weaning

Informations

• Publié par: biomed
• Publié le: 01 janvier 2003
• Nombre de lectures: 3
• Langue: English

Extrait

Available onlinehttp://ccforum.com/content/8/1/R31

Open Access Research The effects of different weaning modes on the endocrine stress response 1 12 3 Guniz Meyanci Koksal, Cem Sayilgan, Oznur Senand Huseyin Oz

1 Senior Resident, Department of Anaesthesiology and Reanimation, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey 2 Resident, Department of Anaesthesiology and Reanimation, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey 3 Professor, Department of Anaesthesiology and Reanimation, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey

Correspondence Guniz Meyanci Koksal, [e-mail]

Received: 3 August 2003

Revisions requested: 26 September 2003

Revisions received: 18 October 2003

Accepted: 10 November 2003

Published: 3 December 2003

Critical Care2004,8:R31R34 (DOI 10.1186/cc2413) This article is online at http://ccforum.com/content/8/1/R31 © 2004 Koksalet al., licensee BioMed Central Ltd (Print ISSN 13648535; Online ISSN 1466609X). This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.

Abstract IntroductionThe aim of the present study was to investigate the effects of the stress response on plasma insulin, cortisol, glucose, and urinary vanilmandelic acid during weaning and after extubation, using pressure support (PS), continuous positive airway pressure (CPAP) and Tpiece modes. MethodsSixty patients were randomly divided into three groups (nThe PS group received= 20). FiO≤0.4, PS≤O, and positive end expiratory pressure10 cmH≤5 cmHO for 2hours. The CPAP 2 22 group was given FiO≤0.4 and CPAP≤T) receivedO for 2hours. The Tpiece group (group5 cmH 2 2 4 l/minoxygen via a Tpiece for 2hours. After 1hour and 2hours in their respective weaning modes, blood and urine samples were taken for insulin, cortisol, glucose and vanilmandelic acid measurements. Fortyeight hours after extubation, blood and urine samples were again taken. ResultsT than in the PS and CPAP groups (Plasma insulin was greater in groupP< 0.01and P< 0.01).The plasma cortisol concentration was greater in group T than in group PS during weaning (Pand after extubation (< 0.05)P< 0.05).Blood glucose concentrations were greater in group T than in the other groups (bothP< 0.01)both during weaning and post extubation. Urine vanilmandelic acid was greater in group T than in the other groups during weaning and after extubation (bothP< 0.001). ConclusionWeaning via the Tpiece caused a greater stress response than the PS and CPAP modes.

Keywordscortisol, insulin, mechanical ventilation, stress response, ventilation modes, weaning

Introduction Intubation and mechanical ventilation are safe and effective treatments for critically ill patients with respiratory failure [1]. However, while unnecessary prolongation of mechanical ven tilation increases the risk of complications, including bron chopulmonary infections, barotrauma, and oxygen toxicity, its premature discontinuation may also increase morbidity and mortality. Intensive care can indeed be prolonged if reintuba tion is needed [2,3]. ‘Weaning’ is the withdrawal of mechani cal ventilatory support, although the term ‘liberation’ may be

more appropriate [4]. Selection of the most appropriate mode for weaning can be difficult [5].

The effect of weaning on the stress response in critically ill patients is uncertain, as are the effects of different weaning modes. The aim of the present study was to compare changes in plasma concentrations of insulin, cortisol and glucose, and in urine vanilmandelic acid (VMA) during weaning and after extubation, using the three different modes of pressure support (PS) ventilation, continuous positive airway pressure (CPAP) and Tpiece, in intensive care patients.

CPAP = continuous positive airway pressure; FiO= fractional inspired oxygen concentration; PaO= partial arterial oxygen tension; PS = 2 2 pressure support; VMA = vanilmandelic acid. R31