• Michele Vitacca, Simonetta Scalvini, Maurizio Volterrani, Enrico Maria Clini, Mara Paneroni, Amerigo Giordano, and Nicolino Ambrosino.
• Respiratory Rehabilitation Division, Salvatore Maugeri Foundation IRCCS, Lumezzane, (BS), Italy. Electronic address: michele.vitacca@fsm.it.
• Heart Lung. 2014 Sep 1; 43 (5): 420-6.

ObjectivesTo evaluate heart rate variability (HRV), hemodynamics, mechanics, dyspnea and blood gases following different mechanical ventilation (MV) settings.BackgroundNo study has evaluated physiological changes during T-piece trials following different MV settings.MethodsIn 8 COPD patients on prolonged MV we applied in random order two MV settings: i) pressure support (PS) 20 cm H2O + positive end-expiratory pressure (PEEP) 0 cm H2O (setting-1) and ii) PS 15 cm H2O + PEEP 5 cm H2O (setting-2), each followed by a 30 min T-piece trial.ResultsSetting-1 induced greater minute ventilation, tidal volume/inspiratory time and lower pulmonary artery occlusion pressure; setting-2 reduced intrinsic PEEP. Mechanics and hemodynamics data did not differ, but all HRV time domain indices were reduced only after setting-1, suggesting a decreased parasympathetic and increased sympathetic cardiac modulation.ConclusionsThe T-piece trial following setting-2 seems less stressful on neural control of HRV. Future studies on T-piece trials should consider the residual effect of the MV setting.Copyright © 2014 Elsevier Inc. All rights reserved.

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