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Reduction in Ventilator Response to CO₂ With Relaxation Feedback During CO₂ Rebreathing in Normal Adults^*

^* From the Department of Critical Care Medicine, St. John's Mercy Medical Center, St. Louis, MO.

Correspondence to: Jerome E. Holliday, PhD, VA Medical Center, Medicine Service 111-JC, 915 N Grand Blvd, St. Louis, MO 63106

Background: Previous studies have shown that relaxation biofeedback reduced time on the ventilator for the difficult-to-wean patients.

Objective: To test the hypothesis that the underlying mechanism of biofeedback ventilator weaning was the reduction of neural respiratory drive (NRD).

Design: Prospective, linear regression analysis.

Setting: Critical care medicine department in tertiary health care hospital.

Subjects: Fifteen healthy adult volunteers were randomly assigned to the biofeedback group, and 15 healthy adult volunteers were randomly assigned to a control group.

Interventions: Relaxation feedback was administered while a single variable, PaCO₂, was inputted to the respiratory control system and the output measured. While rebreathing 7% CO₂/93% O₂, the biofeedback group received a baseline session and a relaxation feedback session and the control group received a baseline session and a no feedback session.

Measurements and results: During relaxation feedback, there was a significant (p < 0.001 to p < 0.05) reduction in the slope of minute ventilation (I), mean inspiratory flow (VT/TI), occlusion pressure in 0.1 s from onset of inspiration (P₁₀₀), respiration rate (RR), and diaphragm (DA) EMG compared to baseline. We also found the above breathing parameters decreased significantly for relaxation feedback (p < 0.001–0.05), compared to baseline, at maximum end-tidal CO₂ (64 ± 1.2 mm Hg) (all data are expressed as mean ± SE). The decrease for I = -4.65 ± 1.17 L/min, DA EMG = -0.4 ± 0.21 µV, P₁₀₀ = -1.13 ± 0.56 cm H₂O, VT/TI = -144 ± 82.91 ml/s, and RR = -3.1 ± 0.79 breaths/min. No significant changes occurred in these parameters for the control group.

Conclusions: We conclude that the addition of the behavioral input of relaxation feedback results in decreasing the values of respiratory parameters that reflect NRD.

Key Words: biofeedback • CO₂ rebreathing • neural respiratory drive • respiration

This article has been cited by other articles:

				J. E. Holliday and M. Lippmann Reduction in Ventilatory Response to CO2 With Relaxation Feedback During CO2 Rebreathing for Ventilator Patients Chest, October 1, 2003; 124(4): 1500 - 1511. [Abstract] [Full Text] [PDF]