ECG derived Cheyne-Stokes respiration and periodic breathing are associated with cardiorespiratory arrest in intensive care unit patients.
Adelita Tinoco, David W Mortara, Xiao Hu and 2 others
PMID 30340809WHAT IT FOUND
The average hourly ECG-derived Cheyne-Stokes and periodic breathing rate was not higher in ICU patients than healthy participants.
But ICU patients with the highest rates had more cardiorespiratory arrest and any adverse event than those with the lowest rates.
Key findings
01The average hourly ECG-derived Cheyne-Stokes and periodic breathing rate did not differ between ICU patients and healthy participants (0.39 versus 0.18).
02ICU hourly rates were much broader than healthy rates, ranging from 0 to 6 versus 0 to 0.51.
03Compared with the lowest quartile, the highest quartile had more cardiorespiratory arrests (5% versus 0%) and more composite adverse events (19% versus 8%).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The ECG-derived Cheyne-Stokes/periodic breathing method was not validated against polysomnography. The study was observational, so it cannot show that the breathing pattern caused arrest or adverse events. Adverse outcomes were few, especially cardiorespiratory arrest, so the association is imprecise. Patients on ventilator, bilevel positive airway pressure, or continuous positive airway pressure were excluded, so findings do not apply to mechanically ventilated ICU patients. Sleep state was not measured, and obstructive sleep apnea history was only from records, so these could influence the breathing pattern signal. The data came from an academic hospital setting with high-acuity ICU patients, so generalizability may be limited.
Declared interests
No author conflict-of-interest statement is provided in the supplied text; the publication types list NIH and non-U.S. government research support.
The easy way to misread this
Do not treat ECG-derived Cheyne-Stokes and periodic breathing as a validated bedside monitor for impending arrest. The method was not validated against polysomnography, the study was observational, and the adverse-event sample was small.